Clinical characteristics and outcomes of 10 uremics with calciphylaxis

Objective To explore the clinical characteristics and outcomes of calciphylaxis in uremics.Methods From January,2019 to December,2019,10 uremics with calciphylaxis were selected.Clinical manifestations,pathological features and outcomes were analyzed retrospectively.Results Ten patients with calciphylaxis were enrolled. There were 5 boys and 5 girls with an average age of(52.3±17.4)years and a median dialysis age of 120(60-153)months. The major clinical feature was distal skin necrotic ulcer with severe intractable pain. More than one half had a previous history of continuous oral dosing of calcium and calcitriol for more than 1 year. The levels of albumin(31.3±5.0)g/L,hemoglobin(91.1±17.3)g/L and serum phosphorus(2.14±0.81)mmol/L were significantly lower in calciphylaxis patients than normal. The levels of similar total calcium and corrected calcium were similar. All of them had secondary hyperparathyroidism and the average historical peak of parathyroid hormone was1488.2 pg/ml. Treatment consisted of intravenous infusion of sodium thiosulfate and such symptomatic measures as analgesics,debridement,wound care,local oxygen therapy and nutritional supports. Overall 1-year mortality was 50%(5/10)at the end of follow-up. Cause of death was sudden cardiogenic arrest(n=4)and septic shock(n=1). The median time from diagnosis to death was 6.1 months(8 days to 11months).Conclusion Calciphylaxis has clinical features of long dialysis age,poor nutritional status,anemia and secondary parathyroidism in uremics. Also calciphylaxis is associated with a high mortality rate.Thus a proper management of parathyroid hormone level should be strengthened. And early diagnosis and prompt treatment are implemented for improving its prognosis.