Is calciphylaxis best treated surgically or medically?

Background. Calciphylaxis is a rare, painful, life-threatening problem of c utaneous necrosis and refractory healing in patients with uremia and second ary hyperparathyroidism. The pathogenesis involves abnormalities in calcium and phosphorus metabolism and acute deposition of calcium in tissues. Method. The clinical course of 16 patients who were diagnosed with calciphy laxis at our institution from 1994 through 1998 was reviewed. Results. Fourteen female patients and 2 male patients had chronic renal dis ease, secondary hyperparathyroidism, and characteristic skin necrosis (mean age, 56 years, range, 39-70 years). All patients underwent intensive medic al therapy, including ongoing hemodialysis (n = 16 patients), parathyroidec tomy (n = 7 patients), and debridement of cutaneous lesions (n = 8 patients ). Mean serum values in surgical and nonsurgical patients were significantl y different for phosphorus, calcium-phosphorus product, and parathormone le vels. Median survival was 9.4 months; 15 patients (93%) have died. The medi an survival time for parathyroidectomy versus nonparathyroidectomy was 14.8 and 6.3 months (P =.22), for skin debridement versus nondebridement was 14 .1 and 6.1 months (P =.08), and for diabetic versus nondiabetic patients wa s 6.5 and 13.9 months (P =.11). Conclusions. Calciphylaxis has a female preponderance, with a dismal progno sis. A multidisciplinary approach that uses frequent hemodialysis to normal ize calcium and phosphorus levels and local debridement of skin lesions see ms prudent. Parathyroidectomy cannot be recommended routinely in all patien ts, unless severe hyperparathyroidism mandates intervention.