Materiały źródłowe

• #1 Calciphylaxis: Risk Factors, Diagnosis, and Treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4696752/

  Calciphylaxis is a rare but devastating condition that has continued to challenge the medical community since its early descriptions in the scientific literature many decades ago. […] In this In Practice feature, we review the available medical literature regarding risk factors, diagnosis, and treatment of both uremic and non-uremic calciphylaxis. […] We hereby provide a summary of recommendations developed by the Massachusetts General Hospital’s Multi-disciplinary Calciphylaxis Team for calciphylaxis patients. […] Despite the well characterized clinical and histological descriptions of calciphylaxis, its exact pathogenesis remains unclear and there is limited data regarding the diagnostic and therapeutic approaches for this devastating condition. […] We provide a summary of recommendations to evaluate and manage calciphylaxis patients developed by the Massachusetts General Hospital’s Multi-disciplinary Calciphylaxis Team.

• #2 Calciphylaxis (calcific uremic arteriolopathy) – UpToDate

  https://www.uptodate.com/contents/calciphylaxis-calcific-uremic-arteriolopathy

  Calciphylaxis is a rare and serious disorder that presents with skin ischemia and necrosis and is characterized histologically by calcification of arterioles and capillaries in the dermis and subcutaneous adipose tissue. […] There is no approved treatment for calciphylaxis. […] This topic reviews the pathogenesis, diagnosis, and treatment of calciphylaxis in ESKD (calcific uremic arteriolopathy) and non-ESKD patients. […] Initial treatment for all patients includes wound care and pain management, treatment of infected wounds, treatment of calcium, phosphorus, and parathyroid hormone abnormalities, dialysis optimization, medication adjustment, and a trial of sodium thiosulfate. […] Monitoring the response to therapy is essential. […] Treatment of resistant disease may involve hyperbaric oxygen therapy and bisphosphonates. […] Experimental therapies are also being explored.

• #3 Calciphylaxis – Wikipedia

  https://en.wikipedia.org/wiki/Calciphylaxis

  The treatment of calciphylaxis requires a multidisciplinary approach, using the knowledge of nephrologists, plastic surgeons, dermatologists, and wound care specialists working together to manage the disease and its outcomes. […] Pain management and choice of analgesia is a challenging task in managing calciphylaxis. Pain is one of the most severe and pervasive symptoms of the disease and can be unresponsive to high-dose opioids. Fentanyl and methadone are preferred analgesics over morphine, since morphine breakdown produces active metabolites that accumulate in the body of patients with kidney failure. Adjunct medications such as gabapentin and ketamine may also be used for analgesia. In refractory cases, spinal anesthetics (nerve blocks) can be used for more comprehensive pain relief. Wound care for calciphylaxis lesions involves using appropriate dressings, wound debridement (removal of dead tissue), and prevention of infection. Wound infections lead to sepsis, which is one of the leading causes of death in patients with calciphylaxis. Surgical wound debridement carries increased risk for infection, so it should only be considered as therapy if the survival benefit outweighs the chances of continued wound non-healing and pain.

• #4 Calciphylaxis Prevention and Treatment Strategies- Clinical Advisor

  https://www.clinicaladvisor.com/features/calciphylaxis-prevention-treatment-strategies/

  Calciphylaxis treatment should include a multimodal approach with a focus on supportive care, infection prevention, pain management, and wound healing. […] Treatment of calciphylaxis should include a multimodal approach with a focus on supportive care, infection prevention, pain management, and wound healing. The focus should be to normalize calcium, dissolve calcium deposits, and general wound care. […] Wound care consists of wound dressing, debridement, and analgesics. Debridement can be conducted surgically or mechanically with extreme cases potentially requiring amputation. However, no standard protocol for debridement exists. Studies have shown that surgical debridement can increase 1-year survival rates from 27.4% without intervention to 61.6%. […] Ulcers are susceptible to infections and antibiotic treatment may be required. Sepsis is a leading cause of mortality in patients; thus, intensive monitoring for signs of (local or systemic) infection is warranted with a low threshold to start systemic antibiotics.

• #5 Calciphylaxis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/calciphylaxis/diagnosis-treatment/drc-20370562

  Often, more than one treatment is needed for calciphylaxis. Treatments can restore oxygen and blood flow to the skin and reduce calcium buildup. […] Medicine that helps keep blood from clotting can restore blood flow to affected tissues. These blood-thinning medicines are called anticoagulants. If these don’t help, an experimental treatment may be available that can dissolve blood clots in the tiny blood vessels of the skin. This treatment is a type of medicine called a low-dose tissue plasminogen activator. […] Another backup treatment option involves breathing pure oxygen in a pressurized chamber. This is called hyperbaric oxygen therapy. It’s not available everywhere. A small amount of research suggests that this therapy may help control infections and limit tissue loss while the main treatments take effect.

• #6 Sodium Thiosulfate for Calciphylaxis Treatment in Patients on Peritoneal Dialysis: A Systematic Review

  https://www.mdpi.com/1648-9144/59/7/1306

  Sodium thiosulfate (STS) treatment for calciphylaxis in peritoneal dialysis (PD) patients has limited data available, while it is well-studied in hemodialysis (HD) patients. A systematic literature search identified 30 PD patients with calciphylaxis who received STS. The administration routes and doses varied depending on the study. For intravenous (IV) administration, STS doses ranged from 3.2 g twice daily to 25 g three times weekly for 5 weeks to 8 months. Outcomes included 44% of patients experiencing successful wound healing, 6% discontinuing STS due to adverse effects, 67% transitioning to HD, and 50% dying from calciphylaxis complications. For intraperitoneal (IP) administration, STS doses ranged from 12.5 to 25 g three to four times weekly for 12 h to 3 months. Results showed 80% of patients achieving successful wound healing, 80% discontinuing STS due to adverse effects, 40% transitioning to HD, and 20% dying from IP STS-related chemical peritonitis.

• #7 Treatment of Calciphylaxis in CKD: A Systematic Review and Meta-analysis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6365410/

  Calciphylaxis is a life-threatening complication of chronic kidney disease (CKD). To inform clinical practice, we performed a systematic review of case reports, case series, and cohort studies to synthesize the available treatment modalities and outcomes of calciphylaxis in patients with CKD. […] Electronic databases were searched for studies that examined the uses of sodium thiosulfate, surgical parathyroidectomy, calcimimetics, hyperbaric oxygen therapy, and bisphosphonates for calciphylaxis in patients with CKD, including end-stage renal disease. […] In the pooled cohorts, case series, and case reports, 50.3% of patients received sodium thiosulfate, 28.7% underwent surgical parathyroidectomy, 25.3% received cinacalcet, 15.3% underwent hyperbaric oxygen therapy, and 5.9% received bisphosphonates.

• #8 Calciphylaxis Treatment & Management: Medical Care, Surgical Care, Diet

  https://emedicine.medscape.com/article/1095481-treatment

  Calcimimetics (eg, cinacalcet hydrochloride) may be beneficial in cases of hyperparathyroidism. These agents increase the sensitivity of the calcium receptors to available calcium, thereby decreasing parathyroid hormone (PTH) secretion. They have been shown to be effective in lowering PTH, calcium, and phosphate levels. Successful use of these agents as adjunctive therapy for calciphylaxis has been reported. […] Bisphosphonates (eg, pamidronate and etridronate) increase osteoprotegerin production and inhibit arterial calcification. Case reports have suggested that these agents may be helpful in some cases of calciphylaxis, even without changing calcium or phosphate levels. […] Marked improvement of calciphylaxis has now been reported with the use of intravenous (IV) sodium thiosulfate. Sodium thiosulfate is a potent antioxidant, and it also increases the solubility of calcium deposits. Success has been reported in uremic and nonuremic calciphylaxis.

• #9 Calciphylaxis: Causes, Symptoms, and Management — DermNet

  https://dermnetnz.org/topics/calciphylaxis

  Meticulous wound management is essential. […] Intravenous infusions of sodium thiosulfate, an antioxidant and chelator, has also been used successfully to remove the calcium. […] Etidronate, a bisphosphonate, has been reported of benefit, but bisphosphonates may not be suitable for patients on haemodialysis. […] Inhibitors of matrix metalloproteinases such as doxycycline have been reported to prevent new lesions forming. […] Iloprost and cinacalcet (a calcimimetic) have also been advocated.

• #10 Calciphylaxis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/calciphylaxis/diagnosis-treatment/drc-20370562

  Wound care is a crucial part of calciphylaxis treatment. So it can be very helpful to have a team of wound care specialists. […] Reducing calcium buildup in arteries may be helped by: […] A medicine called sodium thiosulfate can lower calcium buildup in the small arteries. It’s given through a needle in a vein three times a week, usually during dialysis. Your healthcare professional may recommend that you take a medicine called cinacalcet (Sensipar), which can help control parathyroid hormone (PTH). Other medicines may be used to improve the balance of calcium and phosphorus in your body. […] If an overactive parathyroid gland that makes too much PTH plays a role in your condition, surgery may be a treatment option. Surgery called a parathyroidectomy can remove all or part of the parathyroid glands.

• #11 Can Calciphylaxis Be Cured? Treatment Options

  https://www.medicinenet.com/can_calciphylaxis_be_cured/article.htm

  Infected wounds may be treated with antimicrobial therapy. […] Surgical debridement of the wound may be needed. […] Vacuum-assisted closure devices have been successful in several cases of calciphylaxis after extensive debridement and before skin grafting. […] Management of calcium, phosphorus, and parathyroid hormone abnormalities, which may involve the use of certain medications, such as sevelamer carbonate, lanthanum carbonate, and cinacalcet. Surgical removal of the parathyroid gland (parathyroidectomy) may be done in refractory cases. […] Dialysis optimization by adjusting the duration or frequency of hemodialysis. […] Trial of sodium thiosulfate (STS) may be given for at least 3-4 weeks. STS is a type of salt that may help because of its antioxidant properties and vasodilatory (widening of blood vessels) effects. It is an off-label treatment that has shown a good response in many patients.

• #12 Calciphylaxis Treatment & Management: Medical Care, Surgical Care, Diet

  https://emedicine.medscape.com/article/1095481-treatment

  The use of sodium thiosulfate to treat calciphylaxis is off label, but reports of success have been published. A study of 14 patients suggested that several factors may impact patient outcome. Earlier intervention or a higher total dose of sodium thiosulfate may be more effective but less well tolerated. […] Sodium thiosulfate has been administered IV, intralesionally, or topically; intraperitoneal administration is not recommended owing to the risk of chemical peritonitis. […] Although sodium thiosulfate is generally well tolerated, adverse effects have included nausea with emesis and the development of an anion gap metabolic acidosis that can be managed by altering the bicarbonate level of the dialysate. […] Judicious use of antibiotics may be advantageous. Additionally, in some cases, hyperbaric oxygen may be beneficial to promote wound healing.

• #13

  https://journals.lww.com/aswcjournal/fulltext/2019/05000/calciphylaxis__diagnosis,_pathogenesis,_and.3.aspx

  Sodium thiosulfate appears to be beneficial in a majority of patients with calciphylaxis. […] The best available data on its efficacy come from surveys of clinicians at US hemodialysis centers. […] Sodium thiosulfate also appears to confer a mortality benefit. […] Vitamin K has also successfully treated calciphylaxis in a single patient. […] Treatment consists of a three-pronged approach: (1) optimizing wound management with judicious use of surgical debridement and hyperbaric oxygen therapy, (2) halting progression of vessel wall calcification by ameliorating risk factors of calciphylaxis, and (3) reversing vessel wall calcification with sodium thiosulfate or vitamin K supplementation.

• #14 Calciphylaxis: Symptoms & Causes

  https://my.clevelandclinic.org/health/diseases/22359-calciphylaxis

  Side effects from sodium thiosulfate. These include nausea, vomiting, fluid balance issues, low blood pressure and blood acidity problems. Providers need to consider these issues, particularly in people with heart failure. In many cases, adjusting the dose of this medication or treating the side effect symptoms is effective.

• #15 Calciphylaxis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/calciphylaxis/diagnosis-treatment/drc-20370562

  For sores to heal, some of the tissue damaged by calciphylaxis may need to be removed with surgery. This is called debridement. Sometimes, tissue can be removed using other methods, such as wet dressings. Medicines called antibiotics can clear up infections caused by germs. Antibiotics can help treat and prevent ulcer infections. […] You’ll likely be offered medicines to manage pain due to calciphylaxis or during wound care. A pain medicine specialist may need to be involved if you’re prescribed opioid pain medicines.

• #16 Calciphylaxis – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/calciphylaxis/symptoms-causes/syc-20370559

  Calciphylaxis treatments include various medicines, procedures and surgery. Treatment can help prevent blood clots and infections, reduce calcium buildups, heal sores, and ease pain. […] If you have calciphylaxis, your healthcare team helps you prevent ulcer infections or other complications. You may need to apply special wound dressings or clean the ulcers daily to prevent germs called bacteria from growing.

• #17 Calciphylaxis: Symptoms & Causes

  https://my.clevelandclinic.org/health/diseases/22359-calciphylaxis

  Because researchers dont fully understand calciphylaxis, theres limited guidance on the best calciphylaxis treatment. Currently, the disease isnt curable, but your symptoms can go away if treatment is successful. […] Preventing infection and helping wounds heal are both top priorities. This can include several advanced types of care, like: […] Hyperbaric oxygen therapy. This involves placing you in an airtight chamber with a 100% oxygen atmosphere (instead of the normal oxygen concentration of about 20%). The pressure in the chamber will also be slightly higher than normal. This can be very effective at encouraging wounds to heal. […] Debridement. This is the removal of dead or dying tissue from a wound, helping prevent infection and encouraging the wound to heal. In more severe cases, this may involve surgery.

• #18 Calciphylaxis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/calciphylaxis/diagnosis-treatment/drc-20370562

  For sores to heal, some of the tissue damaged by calciphylaxis may need to be removed with surgery. This is called debridement. Sometimes, tissue can be removed using other methods, such as wet dressings. Medicines called antibiotics can clear up infections caused by germs. Antibiotics can help treat and prevent ulcer infections. […] You’ll likely be offered medicines to manage pain due to calciphylaxis or during wound care. A pain medicine specialist may need to be involved if you’re prescribed opioid pain medicines.

• #19 Calciphylaxis Treatment & Management: Medical Care, Surgical Care, Diet

  https://emedicine.medscape.com/article/1095481-treatment

  Pain management is also crucially important. Hyperbaric oxygen (HBO) therapy may help alleviate pain in these patients; it may also have benefits with respect to wound healing and mortality. […] Aggressive wound care and debridement of necrotic tissue may be necessary to avoid wound infection and sepsis. […] Use of a vacuum-assisted closure (VAC) device has been successful in several cases of calciphylaxis after extensive debridement and prior to skin grafting. […] Total or subtotal parathyroidectomy with autotransplantation may be of therapeutic benefit. Small case studies have demonstrated some benefit; however, larger retrospective studies have not demonstrated a significant difference in survival. […] Patients with abnormalities in calcium and phosphate homeostasis should be referred to a dietitian well versed in the dietary needs and restrictions of patients with end-stage renal disease (ESRD).

• #20 Calciphylaxis: Symptoms & Causes

  https://my.clevelandclinic.org/health/diseases/22359-calciphylaxis

  Skin and tissue grafting. In cases with greater tissue loss, grafts from elsewhere in your body may help with wound repair and healing. […] Antibiotics. These medications can help stop bacterial infections. […] Calciphylaxis is an extremely painful condition, making it harder for you to rest and let your body heal. Providers tend to prescribe opioid pain medications for calciphylaxis. […] This medication, which you get through an IV, may help remove calcium built up in blood vessels or other tissues. […] Ensuring the right levels and balance of minerals in your blood is important to help avoid complications and problems. This also includes making sure your parathyroid hormone levels dont go too low or too high. In some cases, it may involve surgery to remove one or more of your parathyroid glands.

• #21 Calciphylaxis Prevention and Treatment Strategies- Clinical Advisor

  https://www.clinicaladvisor.com/features/calciphylaxis-prevention-treatment-strategies/

  Calciphylaxis treatment should include a multimodal approach with a focus on supportive care, infection prevention, pain management, and wound healing. […] Treatment of calciphylaxis should include a multimodal approach with a focus on supportive care, infection prevention, pain management, and wound healing. The focus should be to normalize calcium, dissolve calcium deposits, and general wound care. […] Wound care consists of wound dressing, debridement, and analgesics. Debridement can be conducted surgically or mechanically with extreme cases potentially requiring amputation. However, no standard protocol for debridement exists. Studies have shown that surgical debridement can increase 1-year survival rates from 27.4% without intervention to 61.6%. […] Ulcers are susceptible to infections and antibiotic treatment may be required. Sepsis is a leading cause of mortality in patients; thus, intensive monitoring for signs of (local or systemic) infection is warranted with a low threshold to start systemic antibiotics.

• #22 Calciphylaxis (Calcific uremic arteriolopathy) – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/dermatology/calciphylaxis-calcific-uremic-arteriolopathy/

  Promoting healing and preventing sepsis are the two main goals of wound care. […] Calcimimetics such as cinacalcet (30-120 mg/day may be used as a safer alternative to surgical parathyroidectomy in patients with secondary hyperparathyroidism or in patients who are not candidates for this procedure. […] Finally, parathyroidectomy with autotransplantation is a controversial treatment modality for calciphylaxis. […] In calciphylaxis refractory to medical and surgical management, hyperbaric oxygen therapy may be particularly valuable for those patients undergoing both peritoneal and hemodialysis. […] Substantial pain management with systemic analgesics, such as high-dose opioids, ketamine, and benzodiazepines, is often necessary as the lesions are exquisitely painful. […] Patients should be informed of the natural history, including morbidity, associated with calciphylaxis before beginning therapy. […] Treatment modalities largely consist of supportive therapy and overall prognosis is poor. […] Patients should be encouraged to minimize all aggravating factors. […] Risks of surgical debridement must be explained, as any physical trauma may in itself exacerbate calciphylaxis.

• #23 Calciphylaxis (Calcific uremic arteriolopathy) – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/dermatology/calciphylaxis-calcific-uremic-arteriolopathy/

  Promoting healing and preventing sepsis are the two main goals of wound care. […] Calcimimetics such as cinacalcet (30-120 mg/day may be used as a safer alternative to surgical parathyroidectomy in patients with secondary hyperparathyroidism or in patients who are not candidates for this procedure. […] Finally, parathyroidectomy with autotransplantation is a controversial treatment modality for calciphylaxis. […] In calciphylaxis refractory to medical and surgical management, hyperbaric oxygen therapy may be particularly valuable for those patients undergoing both peritoneal and hemodialysis. […] Substantial pain management with systemic analgesics, such as high-dose opioids, ketamine, and benzodiazepines, is often necessary as the lesions are exquisitely painful. […] Patients should be informed of the natural history, including morbidity, associated with calciphylaxis before beginning therapy. […] Treatment modalities largely consist of supportive therapy and overall prognosis is poor. […] Patients should be encouraged to minimize all aggravating factors. […] Risks of surgical debridement must be explained, as any physical trauma may in itself exacerbate calciphylaxis.

• #24 Calciphylaxis: Symptoms & Causes

  https://my.clevelandclinic.org/health/diseases/22359-calciphylaxis

  Because researchers dont fully understand calciphylaxis, theres limited guidance on the best calciphylaxis treatment. Currently, the disease isnt curable, but your symptoms can go away if treatment is successful. […] Preventing infection and helping wounds heal are both top priorities. This can include several advanced types of care, like: […] Hyperbaric oxygen therapy. This involves placing you in an airtight chamber with a 100% oxygen atmosphere (instead of the normal oxygen concentration of about 20%). The pressure in the chamber will also be slightly higher than normal. This can be very effective at encouraging wounds to heal. […] Debridement. This is the removal of dead or dying tissue from a wound, helping prevent infection and encouraging the wound to heal. In more severe cases, this may involve surgery.

• #25 Compressing Calciphylaxis – ResusNation

  https://criticalcarenow.com/compressing-calciphylaxis/

  HBOT: Hypovascularity and hypoxic tissue injury are central to the pathophysiology of calciphylaxis. […] Case series and retrospective reviews do suggest some improvement in healing and survival when HBOT is employed early on as an adjunct for the treatment of calciphylaxis. […] Treatment options include sodium thiosulfate, surgical parathyroidectomy, cinacalcet, bisphosphonates, and HBOT. […] Supporting mechanisms for the rationale for use of HBOT include reversal of local tissue hypoxia acutely, and neovascularization and collagen deposition in the long term.

• #26 Multimodal Treatment of Calciphylaxis With Sodium Thiosulfate, Alprostadil, and Hyperbaric Oxygen Therapy | Actas Dermo-Sifiliográficas

  https://actasdermo.org/en-multimodal-treatment-calciphylaxis-with-sodium-articulo-S1578219016301615

  In our patient, IV ST was ineffective until IV alprostadil was added; this led to a rapid improvement in the pain, skin ulcers, and livedo racemosa. We believe that this is an interesting therapeutic association because of the combined blood-vessel calcium chelating effect of IV ST and the vasodilator and antithrombotic effect of the prostaglandins, which help to dilate vessels made rigid by calcium deposits. […] Intralesional ST has also been described in the literature as local treatment for ulcers secondary to calciphylaxis. Treatment with hyperbaric oxygen acts by improving healing through its beneficial effects on neovascularization and fibroblast proliferation and by reducing the risk of infection through the release of reactive oxygen species. It is now considered a safe and viable option as part of a multidisciplinary approach to the treatment of calciphylaxis. […] We therefore consider that the adjuvant role of intravenous alprostadil should be evaluated in cases of severe calciphylaxis that do not respond to standard treatment with IV ST.

• #27 Multimodal Treatment of Calciphylaxis With Sodium Thiosulfate, Alprostadil, and Hyperbaric Oxygen Therapy | Actas Dermo-Sifiliográficas

  https://actasdermo.org/en-multimodal-treatment-calciphylaxis-with-sodium-articulo-S1578219016301615

  In our patient, IV ST was ineffective until IV alprostadil was added; this led to a rapid improvement in the pain, skin ulcers, and livedo racemosa. We believe that this is an interesting therapeutic association because of the combined blood-vessel calcium chelating effect of IV ST and the vasodilator and antithrombotic effect of the prostaglandins, which help to dilate vessels made rigid by calcium deposits. […] Intralesional ST has also been described in the literature as local treatment for ulcers secondary to calciphylaxis. Treatment with hyperbaric oxygen acts by improving healing through its beneficial effects on neovascularization and fibroblast proliferation and by reducing the risk of infection through the release of reactive oxygen species. It is now considered a safe and viable option as part of a multidisciplinary approach to the treatment of calciphylaxis. […] We therefore consider that the adjuvant role of intravenous alprostadil should be evaluated in cases of severe calciphylaxis that do not respond to standard treatment with IV ST.

• #28 Hyperbaric oxygen therapy in patients suffering from wounds in calciphylaxis: a narrative review

  https://www.uhms.org/uhm-search/uhm-journal-volume-47-2020/number-1/hyperbaric-oxygen-therapy-in-patients-suffering-from-wounds-in-calciphylaxis-a-narrative-review.html

  Calcific uremic arteriolopathy (calciphylaxis) is a rare and highly lethal vascular disease. […] Although hyperbaric oxygen (HBO2) therapy has been used in the treatment of calciphylaxis, evidence of its effectiveness is limited. […] To determine whether HBO2 therapy has a beneficial effect in the healing of calciphylaxis ulcers. […] This review included a total of 131 patients with calciphylaxis who were treated with HBO2 therapy; of these, 58 patients (45%) had full response on HBO2 with complete wound closure. […] Patients with calcific uremic arteriolopathy can benefit from HBO2.

• #29 Hyperbaric oxygen therapy in patients suffering from wounds in calciphylaxis: a narrative review

  https://www.uhms.org/uhm-search/uhm-journal-volume-47-2020/number-1/hyperbaric-oxygen-therapy-in-patients-suffering-from-wounds-in-calciphylaxis-a-narrative-review.html

  Calcific uremic arteriolopathy (calciphylaxis) is a rare and highly lethal vascular disease. […] Although hyperbaric oxygen (HBO2) therapy has been used in the treatment of calciphylaxis, evidence of its effectiveness is limited. […] To determine whether HBO2 therapy has a beneficial effect in the healing of calciphylaxis ulcers. […] This review included a total of 131 patients with calciphylaxis who were treated with HBO2 therapy; of these, 58 patients (45%) had full response on HBO2 with complete wound closure. […] Patients with calcific uremic arteriolopathy can benefit from HBO2.

• #30 Can Calciphylaxis Be Cured? Treatment Options

  https://www.medicinenet.com/can_calciphylaxis_be_cured/article.htm

  Hyperbaric oxygen therapy, which typically involves administering oxygen at high pressure (around 2.5 atm) or with a high-flow rate (10-15 L per minute), which is about 90 minutes per day for 25 sessions. […] Low-dose tissue plasminogen activator (TPA), which may be administered to dissolve blood clots in the cutaneous blood vessels (tiny blood vessels of the skin).

• #31 Calciphylaxis Treatment & Management: Medical Care, Surgical Care, Diet

  https://emedicine.medscape.com/article/1095481-treatment

  Therapy for calciphylaxis (also referred to as calcific uremic arteriolopathy) is multifaceted and includes medical and surgical intervention. Aggravating conditions should be addressed, and trigger factors should be eliminated. This may involve discontinuing parenteral iron therapy, calcium supplementation, and vitamin D supplementation. Cessation of warfarin therapy should be considered. Systemic glucocorticoids, though frequently implicated as a trigger, may benefit when given early, unless ulcerated lesions are present. Early use of sodium thiosulfate should be considered. […] In patients with an elevated calcium-phosphate product, serum calcium and phosphate concentrations must be brought to low-normal levels as quickly and safely as possible. Conservative therapy should be tried first, including dietary alteration, use of noncalcium, nonaluminum phosphate binders, and low-calcium bath dialysis. Some benefit may be achieved by increasing the frequency or duration of dialysis sessions.

• #32 Calciphylaxis: treatment, symptoms, causes and diagnosis

  https://www.kidneyresearchuk.org/conditions-symptoms/calciphylaxis/

  If you notice symptoms of calciphylaxis, it is important to let your kidney team know. There is currently no specific treatment, but healthcare providers will try to individualise care to address any underlying causes, such as improving calcium and phosphate levels, or stopping medications such as warfarin. […] If you are on dialysis your medical team might suggest that the amount you have be increased. Wound care and medications to help manage pain and treat, or prevent, infections will also be given. There are a number of new treatments being investigated that might benefit this condition so you may also be invited to take part in a research trial. Even if you are not, you should feel able to ask you doctors about being in a research study (see below). […] If appropriate, kidney dietitians can provide guidance on how to adjust your diet to control your phosphate intake. Whilst some people make a good recovery, sadly around 5 in 10 people with the condition will die within a year of diagnosis.

• #33 Calciphylaxis Treatment & Management: Medical Care, Surgical Care, Diet

  https://emedicine.medscape.com/article/1095481-treatment

  Pain management is also crucially important. Hyperbaric oxygen (HBO) therapy may help alleviate pain in these patients; it may also have benefits with respect to wound healing and mortality. […] Aggressive wound care and debridement of necrotic tissue may be necessary to avoid wound infection and sepsis. […] Use of a vacuum-assisted closure (VAC) device has been successful in several cases of calciphylaxis after extensive debridement and prior to skin grafting. […] Total or subtotal parathyroidectomy with autotransplantation may be of therapeutic benefit. Small case studies have demonstrated some benefit; however, larger retrospective studies have not demonstrated a significant difference in survival. […] Patients with abnormalities in calcium and phosphate homeostasis should be referred to a dietitian well versed in the dietary needs and restrictions of patients with end-stage renal disease (ESRD).

• #34 Calciphylaxis Treatment & Management: Medical Care, Surgical Care, Diet

  https://emedicine.medscape.com/article/1095481-treatment

  Calcimimetics (eg, cinacalcet hydrochloride) may be beneficial in cases of hyperparathyroidism. These agents increase the sensitivity of the calcium receptors to available calcium, thereby decreasing parathyroid hormone (PTH) secretion. They have been shown to be effective in lowering PTH, calcium, and phosphate levels. Successful use of these agents as adjunctive therapy for calciphylaxis has been reported. […] Bisphosphonates (eg, pamidronate and etridronate) increase osteoprotegerin production and inhibit arterial calcification. Case reports have suggested that these agents may be helpful in some cases of calciphylaxis, even without changing calcium or phosphate levels. […] Marked improvement of calciphylaxis has now been reported with the use of intravenous (IV) sodium thiosulfate. Sodium thiosulfate is a potent antioxidant, and it also increases the solubility of calcium deposits. Success has been reported in uremic and nonuremic calciphylaxis.

• #35 Calciphylaxis: Pictures, Definition, Symptoms, Treatment, and Outlook

  https://www.healthline.com/health/calciphylaxis

  Calciphylaxis is a kidney complication causing calcium buildup inside fat and skin blood vessels. It leads to painful skin lesions and often causes serious infection. Clinical trials are investigating treatments. […] Currently, an effective treatment or cure for calciphylaxis isn’t yet available. Today’s treatments focus on: caring for the skin lesions, preventing infections, correcting blood concentrations of calcium and phosphorous. […] Treating the related wounds and lesions might include: enzymatic debriding agents, hydrocolloid or hydrogel dressings, systemic antibiotics (if infection is a concern), hyperbaric oxygen therapy, surgical debridements (removal of damaged or dead wound tissue). […] A health professional may prescribe medications to treat the wounds and to correct atypical calcium and phosphorus concentrations in the blood. These may include: Intravenous sodium thiosulfate: a chelating agent for calcium and iron often used in off-label treatment, Cinacalcet (Sensipar): a drug used to treat high levels of calcium in the blood of people with certain parathyroid gland problems or chronic kidney disease, Phosphorous binders (noncalcium-containing): can reduce the levels of phosphorus in the blood without altering calcium levels.

• #36 Calciphylaxis: A Review | JCAD – The Journal of Clinical and Aesthetic Dermatology

  https://jcadonline.com/calciphylaxis-a-review/

  Calciphylaxis is a condition involving vascular calcification and cutaneous necrosis. The mortality rate is high, with more than 50 percent of patients dying within one year of diagnosis. […] Treatment options include wound care, surgical debridement, sodium thiosulfate, bisphosphonates, and hyperbaric oxygen. […] Wound care is of utmost importance and should include debridement of necrotic tissue periodically. Systemic antibiotics should be used, if indicated. Opioid pain medications should be used instead of morphine as byproducts of morphine can cause hypotension, thereby, slowing the flow in the pannicular arterioles, and thus increasing the risk of thrombosis. Non-calcium, non-aluminum phosphate binder, such as sevelamer, can be used as an adjunctive therapy. […] The role of parathyroidectomy in the treatment of calciphylaxis is controversial. It has been reported to be of some help in patients with primary hyperparathyroidism.

• #37 Calciphylaxis Treatment & Management: Medical Care, Surgical Care, Diet

  https://emedicine.medscape.com/article/1095481-treatment

  Calcimimetics (eg, cinacalcet hydrochloride) may be beneficial in cases of hyperparathyroidism. These agents increase the sensitivity of the calcium receptors to available calcium, thereby decreasing parathyroid hormone (PTH) secretion. They have been shown to be effective in lowering PTH, calcium, and phosphate levels. Successful use of these agents as adjunctive therapy for calciphylaxis has been reported. […] Bisphosphonates (eg, pamidronate and etridronate) increase osteoprotegerin production and inhibit arterial calcification. Case reports have suggested that these agents may be helpful in some cases of calciphylaxis, even without changing calcium or phosphate levels. […] Marked improvement of calciphylaxis has now been reported with the use of intravenous (IV) sodium thiosulfate. Sodium thiosulfate is a potent antioxidant, and it also increases the solubility of calcium deposits. Success has been reported in uremic and nonuremic calciphylaxis.

• #38 Calciphylaxis: A Review | JCAD – The Journal of Clinical and Aesthetic Dermatology

  https://jcadonline.com/calciphylaxis-a-review/

  Bisphosphonate therapy with etidronate disodium has been shown to be effective in treating patients with calciphylaxis. A possible mechanism may involve removing arterial calcification. A dose of 200mg/day for 14 days has been used with success, effectively lowering the calcium-phosphorus levels. […] Sodium thiosulfate (STS) has been used for many years for the treatment of cyanide and cisplatin intoxication. […] Hyperbaric oxygen therapy (HOT) has been reported to be beneficial in the treatment of cutaneous ulcers in calciphylaxis.

• #39 Calciphylaxis Treatment & Management: Medical Care, Surgical Care, Diet

  https://emedicine.medscape.com/article/1095481-treatment

  Therapy for calciphylaxis (also referred to as calcific uremic arteriolopathy) is multifaceted and includes medical and surgical intervention. Aggravating conditions should be addressed, and trigger factors should be eliminated. This may involve discontinuing parenteral iron therapy, calcium supplementation, and vitamin D supplementation. Cessation of warfarin therapy should be considered. Systemic glucocorticoids, though frequently implicated as a trigger, may benefit when given early, unless ulcerated lesions are present. Early use of sodium thiosulfate should be considered. […] In patients with an elevated calcium-phosphate product, serum calcium and phosphate concentrations must be brought to low-normal levels as quickly and safely as possible. Conservative therapy should be tried first, including dietary alteration, use of noncalcium, nonaluminum phosphate binders, and low-calcium bath dialysis. Some benefit may be achieved by increasing the frequency or duration of dialysis sessions.

• #40 Calciphylaxis: Causes, Symptoms, and Management — DermNet

  https://dermnetnz.org/topics/calciphylaxis

  The best treatment for calciphylaxis is not yet clear. When it is associated with warfarin, the anticoagulant should be replaced, eg by heparin. […] The initial step is to normalise the calcium and phosphate product levels and control the hyperphosphataemia associated with renal failure. A calcium and phosphate restricted diet and dialysis with a lower dialysate calcium concentration is important initial management in the calciphylaxis associated with renal failure. […] In patients with a significantly elevated parathyroid hormone that cannot be medically controlled, surgical removal of the parathyroid glands (parathyroidectomy) is thought to reduce pain and promote wound healing, especially in early wound development. […] Some patients may also be treated with anticoagulants to reduce the tendency to form blood clots, but these are not always suitable or helpful. Warfarin can be replaced by heparin in some cases.

• #41 Calciphylaxis Prevention and Treatment Strategies- Clinical Advisor

  https://www.clinicaladvisor.com/features/calciphylaxis-prevention-treatment-strategies/

  Reduction of risk factors associated with calciphylaxis is another component of care, such as avoidance of warfarin and systemic corticosteroid use. Abnormalities in serum calcium and phosphate levels should be corrected with a goal of lowering the plasma calcium-phosphate level to 55 mg2/dL2. […] For patients with chronic kidney disease on hemodialysis, options include increasing the frequency and duration of hemodialysis, using a low calcium dialysate, or temporarily switching to venovenous hemofiltration in patients with rapidly ulcerating calciphylaxis. […] Patients with primary or tertiary hyperparathyroidism refractory to wound care and medical management may consider a parathyroidectomy. […] Management of patients with risk factors for thrombosis utilizing direct oral anticoagulants (DOACs) in addition to other multimodal supportive therapies was shown to be a potential treatment option in a review of 16 cases, with 13 patients treated with DOACs having stable or improved cutaneous disease, and 3 patients having progressive disease.

• #42 Calciphylaxis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/calciphylaxis/diagnosis-treatment/drc-20370562

  Wound care is a crucial part of calciphylaxis treatment. So it can be very helpful to have a team of wound care specialists. […] Reducing calcium buildup in arteries may be helped by: […] A medicine called sodium thiosulfate can lower calcium buildup in the small arteries. It’s given through a needle in a vein three times a week, usually during dialysis. Your healthcare professional may recommend that you take a medicine called cinacalcet (Sensipar), which can help control parathyroid hormone (PTH). Other medicines may be used to improve the balance of calcium and phosphorus in your body. […] If an overactive parathyroid gland that makes too much PTH plays a role in your condition, surgery may be a treatment option. Surgery called a parathyroidectomy can remove all or part of the parathyroid glands.

• #43 Calciphylaxis Treatment & Management: Medical Care, Surgical Care, Diet

  https://emedicine.medscape.com/article/1095481-treatment

  Pain management is also crucially important. Hyperbaric oxygen (HBO) therapy may help alleviate pain in these patients; it may also have benefits with respect to wound healing and mortality. […] Aggressive wound care and debridement of necrotic tissue may be necessary to avoid wound infection and sepsis. […] Use of a vacuum-assisted closure (VAC) device has been successful in several cases of calciphylaxis after extensive debridement and prior to skin grafting. […] Total or subtotal parathyroidectomy with autotransplantation may be of therapeutic benefit. Small case studies have demonstrated some benefit; however, larger retrospective studies have not demonstrated a significant difference in survival. […] Patients with abnormalities in calcium and phosphate homeostasis should be referred to a dietitian well versed in the dietary needs and restrictions of patients with end-stage renal disease (ESRD).

• #44 Calciphylaxis Treatment & Management: Medical Care, Surgical Care, Diet

  https://emedicine.medscape.com/article/1095481-treatment

  Conditions of hypercoagulability should be sought and addressed. Patients with documented conditions of hypercoagulability may benefit from proper and adequate anticoagulation. Successful treatment of calciphylaxis with low-dose tissue plasminogen activator (t-PA) was described in a case report. […] The role of anticoagulation in all cases of calciphylaxis is controversial. Random prophylactic use of warfarin or heparin is not indicated, because precipitation of calciphylaxis has occurred with such use. […] Studies are ongoing regarding the effectiveness of vitamin K supplementation. […] Studies are also ongoing regarding the use of IV SNF472 (hexasodium phytate), the hexasodium salt of myoinositol hexaphosphate, which binds to calcium hydroxyapatite crystals within blood vessels, inhibiting further growth.

• #45 Calciphylaxis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/calciphylaxis/diagnosis-treatment/drc-20370562

  Often, more than one treatment is needed for calciphylaxis. Treatments can restore oxygen and blood flow to the skin and reduce calcium buildup. […] Medicine that helps keep blood from clotting can restore blood flow to affected tissues. These blood-thinning medicines are called anticoagulants. If these don’t help, an experimental treatment may be available that can dissolve blood clots in the tiny blood vessels of the skin. This treatment is a type of medicine called a low-dose tissue plasminogen activator. […] Another backup treatment option involves breathing pure oxygen in a pressurized chamber. This is called hyperbaric oxygen therapy. It’s not available everywhere. A small amount of research suggests that this therapy may help control infections and limit tissue loss while the main treatments take effect.

• #46 Calciphylaxis Treatment & Management: Medical Care, Surgical Care, Diet

  https://emedicine.medscape.com/article/1095481-treatment

  Conditions of hypercoagulability should be sought and addressed. Patients with documented conditions of hypercoagulability may benefit from proper and adequate anticoagulation. Successful treatment of calciphylaxis with low-dose tissue plasminogen activator (t-PA) was described in a case report. […] The role of anticoagulation in all cases of calciphylaxis is controversial. Random prophylactic use of warfarin or heparin is not indicated, because precipitation of calciphylaxis has occurred with such use. […] Studies are ongoing regarding the effectiveness of vitamin K supplementation. […] Studies are also ongoing regarding the use of IV SNF472 (hexasodium phytate), the hexasodium salt of myoinositol hexaphosphate, which binds to calcium hydroxyapatite crystals within blood vessels, inhibiting further growth.

• #47 Calciphylaxis: Causes, Symptoms, and Management — DermNet

  https://dermnetnz.org/topics/calciphylaxis

  The best treatment for calciphylaxis is not yet clear. When it is associated with warfarin, the anticoagulant should be replaced, eg by heparin. […] The initial step is to normalise the calcium and phosphate product levels and control the hyperphosphataemia associated with renal failure. A calcium and phosphate restricted diet and dialysis with a lower dialysate calcium concentration is important initial management in the calciphylaxis associated with renal failure. […] In patients with a significantly elevated parathyroid hormone that cannot be medically controlled, surgical removal of the parathyroid glands (parathyroidectomy) is thought to reduce pain and promote wound healing, especially in early wound development. […] Some patients may also be treated with anticoagulants to reduce the tendency to form blood clots, but these are not always suitable or helpful. Warfarin can be replaced by heparin in some cases.

• #48 Management of Warfarin-Induced Calciphylaxis | CCID

  https://www.dovepress.com/successful-treatment-using-apixaban-in-a-patient-on-hemodialysis-with–peer-reviewed-fulltext-article-CCID

  Calciphylaxis is a rare but serious condition in which microvessel occlusion occurs within the subcutaneous adipose tissue and dermis, leading to painful lesions. […] Due to the unavailability of FDA-approved treatment for calciphylaxis, its management is based on data from observational studies and clinical experience. […] The management strategy for calciphylaxis is based on data from observational studies and clinical experience. Principally, calciphylaxis management involves the discontinuation of offending agents, optimal pain management, dialysis, daily wound care, correction of hypercalcemia and hyperphosphatemia, and avoidance of hyperparathyroidism. […] There is limited literature on the use of DOAC therapy as a successful alternative to warfarin in patients on dialysis with calciphylaxis. A retrospective analysis determined that apixaban is a safe and effective alternative to warfarin in patients experiencing calciphylaxis. […] In our patient, the shift to apixaban therapy was well tolerated, with no new calcific lesion development occurring after the transition. […] Apixaban is a safe alternative to warfarin in calciphylaxis as shown in our case. More studies are needed to prove its safety for this condition.

• #49 Calciphylaxis Treatment & Management: Medical Care, Surgical Care, Diet

  https://emedicine.medscape.com/article/1095481-treatment

  Conditions of hypercoagulability should be sought and addressed. Patients with documented conditions of hypercoagulability may benefit from proper and adequate anticoagulation. Successful treatment of calciphylaxis with low-dose tissue plasminogen activator (t-PA) was described in a case report. […] The role of anticoagulation in all cases of calciphylaxis is controversial. Random prophylactic use of warfarin or heparin is not indicated, because precipitation of calciphylaxis has occurred with such use. […] Studies are ongoing regarding the effectiveness of vitamin K supplementation. […] Studies are also ongoing regarding the use of IV SNF472 (hexasodium phytate), the hexasodium salt of myoinositol hexaphosphate, which binds to calcium hydroxyapatite crystals within blood vessels, inhibiting further growth.

• #50 BEATing  Calciphylaxis with an Adaptive Platform design — NephJC

  http://www.nephjc.com/news/beat-calci

  Although 3 randomized clinical trials of sodium thiosulfate have been attempted for calciphylaxis including CALISTA, no results of these studies have been reported or published. But sodium thiosulfate is commonly used to treat calciphylaxis. Bisphosphonates have been proposed to offer benefit for patients with calciphylaxis. A prospective series of 11 patients with calciphylaxis on dialysis found that the addition of bisphosphonates slowed calciphylaxis progression in all patients 2-4 weeks after starting treatment, and improved outcomes when used with supportive care. Vitamin K may also play a role in the treatment of calciphylaxis. Vitamin K deficiency is implicated in calciphylaxis via reducing gamma-carboxylation of matrix Gla protein (MGP)- a calcification inhibitor. In Vit-K CUA, a phase 2 RCT of 26 patients with calciphylaxis, oral phytonadione reduced uncarboxylated MGP. Results were just published as late-breaking poster in Kidney Week this month and demonstrated that phytonadione therapy led to improvements in pain intensity and total lesion surface area in a higher number of patients compared with placebo. The effect of phytonadione was seen even in the absence of application of cinacalcet and intralesional sodium thiosulfate. A larger phase 3 study is now planned to establish the efficacy and safety of this agent in calciphylaxis.

• #51 Calciphylaxis: Risk Factors, Diagnosis, and Treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4696752/

  Surgical wound debridement should be considered on a case-by-case basis. […] Hyperbaric oxygen therapy can be considered as a second line treatment if wounds not improving. […] Pain management is one of the most challenging aspects of calciphylaxis and many patients report severe pain despite administration of potent analgesics.

• #52 Calciphylaxis – Wikipedia

  https://en.wikipedia.org/wiki/Calciphylaxis

  The treatment of calciphylaxis requires a multidisciplinary approach, using the knowledge of nephrologists, plastic surgeons, dermatologists, and wound care specialists working together to manage the disease and its outcomes. […] Pain management and choice of analgesia is a challenging task in managing calciphylaxis. Pain is one of the most severe and pervasive symptoms of the disease and can be unresponsive to high-dose opioids. Fentanyl and methadone are preferred analgesics over morphine, since morphine breakdown produces active metabolites that accumulate in the body of patients with kidney failure. Adjunct medications such as gabapentin and ketamine may also be used for analgesia. In refractory cases, spinal anesthetics (nerve blocks) can be used for more comprehensive pain relief. Wound care for calciphylaxis lesions involves using appropriate dressings, wound debridement (removal of dead tissue), and prevention of infection. Wound infections lead to sepsis, which is one of the leading causes of death in patients with calciphylaxis. Surgical wound debridement carries increased risk for infection, so it should only be considered as therapy if the survival benefit outweighs the chances of continued wound non-healing and pain.

• #53 Perioperative Management of Calciphylaxis: Literature Review and Treatment Recommendations | Published in Orthopedic Reviews

  https://orthopedicreviews.openmedicalpublishing.org/article/37573-perioperative-management-of-calciphylaxis-literature-review-and-treatment-recommendations

  Currently, no standard treatment protocol exists for calciphylaxis nor are comprehensive guidelines available for perioperative care of patients with calciphylaxis. […] Although a standard protocol does not exist for treating calciphylaxis, the literature search identified several common therapies being used including intravenous sodium thiosulfate, parathyroidectomy, surgical debridement, bisphosphonate, cinacalcet, and hyperbaric oxygen therapy. […] A multifactorial approach that includes nerve blocks, renal-sparing opioids, benzodiazepines, and/or ketamine is recommended to optimize postoperative pain.

• #54 FF #325 Uremic Calciphylaxis | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/uremic-calciphylaxis/

  The mechanism of pain is poorly understood, but is thought to be due to ischemia and resultant nerve damage. No controlled studies have confirmed an optimal analgesic approach. However, case series suggest that combining aggressive wound care with an analgesia regimen consisting of opioids, ketamine, and non-opioid adjuvants (e.g., gabapentin or tricyclic antidepressants) can be effective. […] Considering the one-year mortality risk, the diagnosis of calciphylaxis should prompt clinicians to engage patients and families in a larger discussion regarding advance directives, prognosis, and goals of care.

• #55 Calciphylaxis – Wikipedia

  https://en.wikipedia.org/wiki/Calciphylaxis

  The treatment of calciphylaxis requires a multidisciplinary approach, using the knowledge of nephrologists, plastic surgeons, dermatologists, and wound care specialists working together to manage the disease and its outcomes. […] Pain management and choice of analgesia is a challenging task in managing calciphylaxis. Pain is one of the most severe and pervasive symptoms of the disease and can be unresponsive to high-dose opioids. Fentanyl and methadone are preferred analgesics over morphine, since morphine breakdown produces active metabolites that accumulate in the body of patients with kidney failure. Adjunct medications such as gabapentin and ketamine may also be used for analgesia. In refractory cases, spinal anesthetics (nerve blocks) can be used for more comprehensive pain relief. Wound care for calciphylaxis lesions involves using appropriate dressings, wound debridement (removal of dead tissue), and prevention of infection. Wound infections lead to sepsis, which is one of the leading causes of death in patients with calciphylaxis. Surgical wound debridement carries increased risk for infection, so it should only be considered as therapy if the survival benefit outweighs the chances of continued wound non-healing and pain.

• #56 Calciphylaxis: Symptoms & Causes

  https://my.clevelandclinic.org/health/diseases/22359-calciphylaxis

  Skin and tissue grafting. In cases with greater tissue loss, grafts from elsewhere in your body may help with wound repair and healing. […] Antibiotics. These medications can help stop bacterial infections. […] Calciphylaxis is an extremely painful condition, making it harder for you to rest and let your body heal. Providers tend to prescribe opioid pain medications for calciphylaxis. […] This medication, which you get through an IV, may help remove calcium built up in blood vessels or other tissues. […] Ensuring the right levels and balance of minerals in your blood is important to help avoid complications and problems. This also includes making sure your parathyroid hormone levels dont go too low or too high. In some cases, it may involve surgery to remove one or more of your parathyroid glands.

• #57 Vitamin K Explored as Calciphylaxis Treatment – Renal and Urology News

  https://www.renalandurologynews.com/reports/vitamin-k-phytonadione-explored-as-calciphylaxis-treatment/

  Vitamin K may improve calciphylaxis outcomes in patients on hemodialysis, according to early data presented at the American Society of Nephrologys Kidney Week 2023 conference. […] There is no approved therapy for calciphylaxis, a serious vascular calcification disorder that predominantly occurs in patients with end-stage kidney disease, noted Sagar U. Nigwekar, MD, MMSc, of Massachusetts General Hospital in Boston, and colleagues. […] Significantly higher proportions of patients in the phytonadione than placebo group had improvement in pain intensity (92% vs 8%) and total lesion surface area (69% vs 31%), Dr Nigwekars team reported in a poster presentation. […] Intralesional sodium thiosulfate or cinacalcet by themselves were not associated with improvements in clinical outcomes, the authors noted.

• #58 Vitamin K: A Breakthrough Treatment for Calciphylaxis — WoundCentrics, LLC

  https://www.woundcentrics.com/articles/2024/12/29/d7z17f60jsehef6fy0l5f6b0iggo3u

  Vitamin K: A Breakthrough Treatment for Calciphylaxis […] Calciphylaxis, a severe condition characterized by calcification of small to medium-sized blood vessels leading to skin necrosis and potential organ failure, and an incredibly high one year mortality rate of up to 70%, has posed significant management challenges. Recent advances, however, have illuminated a promising treatment modality: vitamin K. Specifically, studies indicate that vitamin K’s role in activating the matrix Gla protein (MGP) – an inhibitor of vascular calcification – addresses the core pathophysiology of calciphylaxis. […] This brings us to the groundbreaking findings of a recent study. In a 12-week phase 2 study that enrolled 26 patients with calciphylaxis, Sagar U. Nigwekar, MD, MMSc, of Massachusetts General Hospital in Boston, and colleagues found that patients treated with oral phytonadione, a form of vitamin K, was associated with a significantly lower mortality rate compared with placebo at 12 weeks (0% vs 31%).

• #59 Calciphylaxis Treatment & Management: Medical Care, Surgical Care, Diet

  https://emedicine.medscape.com/article/1095481-treatment

  Conditions of hypercoagulability should be sought and addressed. Patients with documented conditions of hypercoagulability may benefit from proper and adequate anticoagulation. Successful treatment of calciphylaxis with low-dose tissue plasminogen activator (t-PA) was described in a case report. […] The role of anticoagulation in all cases of calciphylaxis is controversial. Random prophylactic use of warfarin or heparin is not indicated, because precipitation of calciphylaxis has occurred with such use. […] Studies are ongoing regarding the effectiveness of vitamin K supplementation. […] Studies are also ongoing regarding the use of IV SNF472 (hexasodium phytate), the hexasodium salt of myoinositol hexaphosphate, which binds to calcium hydroxyapatite crystals within blood vessels, inhibiting further growth.

• #60 Calciphylaxis: Hexasodium Fytate as a Potential Treatment for a Devastating Disease in: Kidney News Volume 16 Issue 12 (2024)

  https://www.kidneynews.org/view/journals/kidney-news/16/12/article-p34_18.xml

  Calciphylaxis, or calcific uremic arteriolopathy (CUA), is a disorder of mineralization characterized by arterial calcification in the dermis and subcutaneous adipose tissue. […] There are currently no approved therapies for this disease. […] At present, management focuses on excellent wound care, minimization of cutaneous trauma, maintenance of normal calcium and phosphorus concentrations, treatment of hyperparathyroidism, discontinuation of vitamin D analogues, and avoidance of vitamin K antagonists. Case reports suggest a potential role for bisphosphonates (pyrophosphate analogues) and hyperbaric oxygen therapy. The administration of intravenous or intralesional sodium thiosulfate has become a mainstay of therapy, although the efficacy remains uncertain. […] Hexasodium fytate is a manufactured hexasodium salt of myo-inositol hexaphosphate, a naturally occurring substance that binds hydroxyapatite. Hexasodium fytate binds to and slows the growth of hydroxyapatite crystals, thus potentially disrupting a proposed step in the pathogenesis of calciphylaxis.

• #61

  https://link.springer.com/article/10.1007/s12325-020-01504-w

  Patients with CP whose disease remains inadequately controlled even after optimization of calcium, phosphate, and PTH levels and a trial of STS may benefit from second-line therapy. […] Investigative therapies have been used in patient with treatment-resistant CP including sterile maggot therapy, tissue plasminogen activator infusion, vitamin K supplementation, and prednisone. […] All decisions to pursue such therapies should be guided by patient-related risk factors. […] Currently, there are multiple clinical trials in progress in order to provide relief to patients with this debilitating disease.

• #62

  https://link.springer.com/article/10.1007/s12325-020-01504-w

  Patients with CP whose disease remains inadequately controlled even after optimization of calcium, phosphate, and PTH levels and a trial of STS may benefit from second-line therapy. […] Investigative therapies have been used in patient with treatment-resistant CP including sterile maggot therapy, tissue plasminogen activator infusion, vitamin K supplementation, and prednisone. […] All decisions to pursue such therapies should be guided by patient-related risk factors. […] Currently, there are multiple clinical trials in progress in order to provide relief to patients with this debilitating disease.

• #63 Multimodal Treatment of Calciphylaxis With Sodium Thiosulfate, Alprostadil, and Hyperbaric Oxygen Therapy | Actas Dermo-Sifiliográficas

  https://actasdermo.org/en-multimodal-treatment-calciphylaxis-with-sodium-articulo-S1578219016301615

  Calciphylaxis is characterized by calcification of the media of the small arteries and arterioles of the skin, provoking cutaneous ischemia. It affects patients with end-stage renal disease (ESRD) on hemodialysis and carries a high morbidity and mortality, with death most commonly due to sepsis. We describe the case of a patient with calciphylaxis treated successfully with multimodal therapy including sodium thiosulfate (ST) and prostaglandins. […] The patient was treated with intravenous (IV) ST, 25mg, administered immediately after each hemodialysis session, with no clinical response. […] After 36 sessions of IV ST with no clinical response, we added treatment with IV alprostadil, 60g, administered during each hemodialysis session. From the first infusion of alprostadil, the patient reported rapid pain relief that enabled the opioids to be withdrawn. With this combination, the skin ulcers and livedo racemosa improved progressively.

• #64 Calciphylaxis: Causes, Symptoms, and Management — DermNet

  https://dermnetnz.org/topics/calciphylaxis

  Meticulous wound management is essential. […] Intravenous infusions of sodium thiosulfate, an antioxidant and chelator, has also been used successfully to remove the calcium. […] Etidronate, a bisphosphonate, has been reported of benefit, but bisphosphonates may not be suitable for patients on haemodialysis. […] Inhibitors of matrix metalloproteinases such as doxycycline have been reported to prevent new lesions forming. […] Iloprost and cinacalcet (a calcimimetic) have also been advocated.

• #65 BEATing  Calciphylaxis with an Adaptive Platform design — NephJC

  http://www.nephjc.com/news/beat-calci

  Better Evidence and Translation for Calciphylaxis (BEAT-Calci) is a global randomized, adaptive, multi-center, platform trial that will evaluate multiple interventions across several domains of therapeutic care. […] The primary objective of the Dialysis Membrane Domain is to investigate whether treatment with medium cut-off hemodialysis is superior to high flux hemodialysis in improving outcomes measured on the BEAT-Calci Wound Assessment Scale, in patients with kidney failure and newly diagnosed calciphylaxis. […] The primary objective of the Pharmacotherapy Domain is to investigate whether treatment with any of the active interventions within the domain are superior to placebo in improving outcomes measured on the BEAT-Calci Wound Assessment Scale, in patients with kidney failure and newly diagnosed calciphylaxis.

• #66 BEATing  Calciphylaxis with an Adaptive Platform design — NephJC

  http://www.nephjc.com/news/beat-calci

  Despite not having effective and proven therapies till date the future looks promising with the ongoing BEAT Calci and other clinical trials such as Calciphyx- phase 3 RCT presented at ASNs Kidney Week 2023 studying SNF472, and RHEO-CAL which is an RCT to compare the efficacy of rheopheresis as adjuvant treatment.

• #67 BEATing  Calciphylaxis with an Adaptive Platform design — NephJC

  http://www.nephjc.com/news/beat-calci

  Despite not having effective and proven therapies till date the future looks promising with the ongoing BEAT Calci and other clinical trials such as Calciphyx- phase 3 RCT presented at ASNs Kidney Week 2023 studying SNF472, and RHEO-CAL which is an RCT to compare the efficacy of rheopheresis as adjuvant treatment.

• #68 Calciphylaxis Program

  https://www.massgeneral.org/medicine/nephrology/treatments-and-services/calciphylaxis

  The CALISTA trial, the first Phase 3 randomized, placebo controlled trial for calciphylaxis, provided an opportunity to understand the efficacy and safety of intravenous sodium thiosulfate in the treatment of hemodialysis patients with calciphylaxis. […] At present, there is no effective treatment for calcific uremic arteriolopathy. […] However, the effects of vitamin K supplementation in patients with calcific uremic arteriolopathy are unknown. […] The purpose of this study was to conduct a pilot randomized controlled trial to examine the effects of oral vitamin K supplementation on circulating levels of anti-calcification factor (carboxylated Matrix Gla Protein) and clinical outcomes in patients with calcific uremic arteriolopathy.

• #69 Calciphylaxis – Wikipedia

  https://en.wikipedia.org/wiki/Calciphylaxis

  Overall, the clinical prognosis for calciphylaxis is poor. The 1-year mortality rate in patients who have end-stage kidney disease is 45-80%. Response to treatment is not guaranteed. The most common cause of death in calciphylaxis patients is sepsis, severe infection originating from a non-healing ulcer.

• #70 Calciphylaxis – Wikipedia

  https://en.wikipedia.org/wiki/Calciphylaxis

  Overall, the clinical prognosis for calciphylaxis is poor. The 1-year mortality rate in patients who have end-stage kidney disease is 45-80%. Response to treatment is not guaranteed. The most common cause of death in calciphylaxis patients is sepsis, severe infection originating from a non-healing ulcer.

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