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Abstract: PO0557

Calciphylaxis: An Uncommon Skin Manifestation in Non-Dialysis CKD Patients

Session Information

Category: Trainee Case Report

  • 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Sarwar, Rabia, Skagit Regional Health, Mount Vernon, Washington, United States
  • Zubair, Ujala, Jinnah Sindh Medical University, Karachi, Sindh, Pakistan
  • Ananthapanyasut, Wanwarat, Skagit Regional Health, Mount Vernon, Washington, United States
Introduction

Calciphylaxis is a rare but fatal skin disorder seen in 1-4% of dialysis patients. It is characterized by ischemia and necrosis of the skin tissue due to the deposition of calcium in the arterioles and subcutaneous tissues. The risk of infection is increased, and once ulceration develops, the mortality rate can be above 80%. Risk factors include diabetes, warfarin, vitamin D, obesity, female, white race and mineral-bone disorder. The skin findings ranging from livedo reticularis to nodules, plaques, or deep ulcerations. The treatment is focused on supportive care. To date, there is no strong studies to suggest that sodium thiosulfate (STS), bisphosphonates, or calcimimetics are curative. However, STS is commonly used despite the lack of strong supporting data.

Case Description

We report a case of a 76-year-old Caucasian woman with a history of stage G4/A3 chronic kidney disease, insulin-dependent diabetes, hypertension, secondary hyperparathyroidism, and obesity, who presented with severe pain and redness on both legs. The skin lesions had progressed to the painful ulcerations and eschars on both shins one month after the initial visit. A skin biopsy was performed and histopathology was consistent with calciphylaxis. She was started on STS 25 mg intravenously (IV) twice a week and cinacalcet 30 mg by oral route (PO) thrice a week. The patient showed improvement within one month of the treatment.

Discussion

Calciphylaxis in non-dialysis patients is uncommon; however, it should be considered in those with predilection factors. The skin biopsy is crucial for the diagnosis, which can lead to proper management of such a rare yet lethal disease. STS is the most common drug used to treat calciphylaxis. It acts as a calcium chelator with some antioxidative and vasodilation properties leading to recovery.