Treatment of Calciphylaxis in CKD: A Systematic Review and Meta-analysis.

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Abstract

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.

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Most cited references 177

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Calciphylaxis: risk factors, diagnosis, and treatment.

Sagar Nigwekar, Daniela Kroshinsky, Rosalynn Nazarian … (2015)

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. It is predominantly seen in patients with chronic kidney failure treated with dialysis (uremic calciphylaxis) but is also described in patients with earlier stages of chronic kidney disease and with normal kidney function. In this review, we discuss the available medical literature regarding risk factors, diagnosis, and treatment of both uremic and nonuremic calciphylaxis. High-quality evidence for the evaluation and management of calciphylaxis is lacking at this time due to its rare incidence and poorly understood pathogenesis and the relative paucity of collaborative research efforts. We hereby provide a summary of recommendations developed by a multidisciplinary team for patients with calciphylaxis.

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Vascular calcification in chronic kidney disease: an update.

Georg Schlieper, Leon Schurgers, Vincent M Brandenburg … (2016)

Cardiovascular calcification is both a risk factor and contributor to morbidity and mortality. Patients with chronic kidney disease (and/or diabetes) exhibit accelerated calcification of the intima, media, heart valves and likely the myocardium as well as the rare condition of calcific uraemic arteriolopathy (calciphylaxis). Pathomechanistically, an imbalance of promoters (e.g. calcium and phosphate) and inhibitors (e.g. fetuin-A and matrix Gla protein) is central in the development of calcification. Next to biochemical and proteinacous alterations, cellular processes are also involved in the pathogenesis. Vascular smooth muscle cells undergo osteochondrogenesis, excrete vesicles and show signs of senescence. Therapeutically, measures to prevent the initiation of calcification by correcting the imbalance of promoters and inhibitors appear to be essential. In contrast to prevention, therapeutic regression of cardiovascular calcification in humans has been rarely reported. Measures to enhance secondary prevention in patients with established cardiovascular calcifications are currently being tested in clinical trials.

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Distinguishing case series from cohort studies.

Jack C. M. Dekkers, Jan P. Vandenbroucke, Matthias Egger … (2012)

Case series are a commonly reported study design, but the label "case series" is used inconsistently and sometimes incorrectly. Mislabeling impairs the appropriate indexing and sorting of evidence. This article tries to clarify the concept of case series and proposes a way to distinguish them from cohort studies. In a cohort study, patients are sampled on the basis of exposure and are followed over time, and the occurrence of outcomes is assessed. A cohort study may include a comparison group, although this is not a necessary feature. A case series may be a study that samples patients with both a specific outcome and a specific exposure, or one that samples patients with a specific outcome and includes patients regardless of whether they have specific exposures. Whereas a cohort study, in principle, enables the calculation of an absolute risk or a rate for the outcome, such a calculation is not possible in a case series.

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Author and article information

Journal

Journal ID (iso-abbrev): Kidney Int Rep

Title: Kidney international reports

Publisher: Elsevier BV

ISSN (Electronic): 2468-0249

ISSN (Print): 2468-0249

Publication date (Electronic): Feb 2019

Volume: 4

Issue: 2

Affiliations

[1 ] Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.

[2 ] Department of Medicine, St. Elizabeth's Medical Center, Boston, Massachusetts, USA.

[3 ] Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA.

Article

Publisher Item ID: S2468-0249(18)30223-7

DOI: 10.1016/j.ekir.2018.10.002

PMC ID: 6365410

PubMed ID: 30775620

SO-VID: 305f6712-056b-476c-9a56-c33a7c4f536b

History

Keywords: systematic review,calciphylaxis,meta-analysis,chronic kidney disease

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Keywords: systematic review, calciphylaxis, meta-analysis, chronic kidney disease

Treatment of Calciphylaxis in CKD: A Systematic Review and Meta-analysis.

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Abstract

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Most cited references 177

Calciphylaxis: risk factors, diagnosis, and treatment.

Vascular calcification in chronic kidney disease: an update.

Distinguishing case series from cohort studies.

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Affiliations

Article

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