CALCIPHYLAXIS IN PATIENTS ON HEMODIALYSIS - A PREVALENCE STUDY

Background. Calciphylaxis is characterized by painful, violaceous, mot tled shin lesions (livedo reticularis that may progress to tissue necr osis, nonhealing ulcers, gangrene, and potentially amputation, sepsis, or death. The prevalence and characteristics of patients who have cal ciphylaxis need further identification to predict which patients on di alysis may benefit from close monitoring or early surgical interventio n. Methods. All 242 patients undergoing hemodialysis in an outpatient unit were reviewed retrospectively during a 15-month cross-sectional s tudy of the prevalence and characteristics of calciphylaxis. Results, Ten patients (prevalence, 4.1%) had calciphylaxis. Patients with calci phylaxis 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), phos phate (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/m l; p < 0.0001), and alkaline phosphatase levels (288 versus 89 IU/L; p = 0.0001). Bone surveys were positive in all 10 patients with calciph ylaxis compared with 49 (21%) of the 232 patients without calciphylaxi s (p < 0.0001). All patients who underwent parathyroidectomy for calci phylaxis had dramatic healing of the ulcers. Conclusions, The presence of calciphylaxis is higher among younger patients who had undergone l onger periods of hemodialysis. Therefore this group of patients should be monitored aggressively and treated expeditiously for complications of secondary hyperparathyroidism.