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Abstract
Calciphylaxis is characterized by painful, violaceous, mottled skin lesions (livedo
reticularis) that may progress to tissue necrosis, nonhealing ulcers, gangrene, and
potentially amputation, sepsis, or death. The prevalence and characteristics of patients
who have calciphylaxis need further identification to predict which patients on dialysis
may benefit from close monitoring or early surgical intervention.
All 242 patients undergoing hemodialysis in an outpatient unit were reviewed retrospectively
during a 15-month cross-sectional study of the prevalence and characteristics of calciphylaxis.
Ten patients (prevalence, 4.1%) had calciphylaxis. Patients with calciphylaxis were
significantly younger (49 versus 60 years; p = 0.01), had undergone hemodialysis longer
(80 versus 20 months; p < 0.0001), and had higher median serum calcium (9.7 versus
9.2 mg/dl; p = 0.03), phosphate (8.2 versus 5.7 mg/dl; p = 0.001), calcium phosphate
product (81.5 versus 52.9; p = 0.0004), parathyroid hormone (1496 versus 138 pg/ml;
p < 0.0001), and alkaline phosphatase levels (188 versus 89 IU/L; p = 0.0001). Bone
surveys were positive in all 10 patients with calciphylaxis compared with 49 (21%)
of the 232 patients without calciphylaxis (p < 0.0001). All patients who underwent
parathyroidectomy for calciphylaxis had dramatic healing of the ulcers.
The presence of calciphylaxis is higher among younger patients who had undergone longer
periods of hemodialysis. Therefore this group of patients should be monitored aggressively
and treated expeditiously for complications of secondary hyperparathyroidism.