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Abstract: PO0387

Calciphylaxis (Calcific Uremic Arteriolopathy) in a Predominantly African-American Urban US Patient Population

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical

Authors

  • Mudunuru, Sitarama Arvind, Emory University, Atlanta, Georgia, United States
  • Navarrete, Jose E., Emory University, Atlanta, Georgia, United States
  • Armour, Doris J., Emory University, Atlanta, Georgia, United States
  • Cobb, Jason, Emory University, Atlanta, Georgia, United States
Background

Calcific Uremic Arteriolopathy (CUA) which is commonly called calciphylaxis is a rare and serious condition characterized by painful skin ulcerations due to ischemia with necrosis of the skin. The disorder carries a mortality rate > 50% in the first year, and death is often due to recurrent infections. Risk factors for calciphylaxis includes end-stage renal disease (ESRD), a history of diabetes, obesity, female gender, Caucasian race, and the use of medications such as warfarin. We present clinical characteristics of CUA patients admitted to a large academic medical center which serves as a CUA referral center due to the presence of a wound center with hyperbaric oxygen therapy available.

Methods

Retrospective chart review of CUA patients from 2001-2019 in our single center academic hospital. Baseline data reported included age, calcium, phosphorus, PTH, albumin, hemoglobin, creatinine, BUN, the use of medications such as warfarin or steroids, and treatment options.

Results

There were 110 patients included. Patient identified racial (n=108) make-up included African-American (n=89), Caucasian (n=18), and Asian (n=1). Average age was 56±14 years and 80% of patients were female (n=88). Also, 59% (n=65) of patients were diabetic. Dialysis modalities included hemodialysis (n=82) and peritoneal dialysis (n=24). Also 4 patients with CKD not yet on dialysis at the time of diagnosis. Average calcium levels of 8.9±1.1 mg/dL and phosphorus of 5.1±1.9 mg/dL. The average PTH was 569.6±714.9 pg/mL, albumin 2.5±0.7 g/dL, and hemoglobin 9.8±1.7 g/dL. Approximately 50% of patients received hyperbaric oxygen therapy as inpatient, 25% received sodium thiosulfate therapy, and 20% received a surgical intervention during the admission. Approximately 33% of patients were currently or recently on warfarin therapy, and approximately 25% were currently or recently exposed to high dose steroids.

Conclusion

We reported the largest single center and predominantly African-American (81%) calciphylaxis case series. In comparison to other reported calciphylaxis series our average PTH was lower and a high percentage of our patients were using warfarin or steroids. The PTH levels were higher in the African American group compared to others. Also, with a lower than expected parathyroidectomy rate which is likely due to our lower than average PTH.