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Abstract: PO0564

Calciphylaxis in a Cohort with Normal Kidney Function: Improved Survival Compared to ESKD

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical

Authors

  • Hassanein, Mohamed, Cleveland Clinic, Cleveland, Ohio, United States
  • Ababneh, Emad, Cleveland Clinic, Cleveland, Ohio, United States
  • Saad, Anas, Cleveland Clinic, Cleveland, Ohio, United States
  • Cook, Eleanor E., Cleveland Clinic, Cleveland, Ohio, United States
  • Fernandez, Anthony P., Cleveland Clinic, Cleveland, Ohio, United States
  • Ko, Jennifer S., Cleveland Clinic, Cleveland, Ohio, United States
  • Billings, Steven D., Cleveland Clinic, Cleveland, Ohio, United States
  • Fatica, Richard A., Cleveland Clinic, Cleveland, Ohio, United States
  • Vachharajani, Tushar J., Cleveland Clinic, Cleveland, Ohio, United States
Background

Calciphylaxis is a rare, devastating disease, characterized by vascular calcification and is associated with increased mortality.

Methods

We studied the baseline characteristics and outcomes of 78 patients with biopsy-proven calciphylaxis that were stratified according to glomerular filtration rate (GFR) into normal kidney function (NKF): GFR ≥ 90 mL/min/1.73 m2, chronic kidney disease (CKD): GFR 15 – 89 mL/min/1.73 m2, and end-stage kidney disease (ESKD): GFR <15 mL/min/1.73 m2.

Results

Forty-seven patients (60%) with calciphylaxis had ESKD, compared to 22 patients (28%) with CKD and 9 patients (12%) with NKF. Patients with NKF were younger (median age 55 years compared to 69 years in CKD and 65 years in ESKD, p=0.006). Across all 3 groups, there was a predominance of female gender, obesity, multiple and peripheral lesions involving the extremities. Among patients with ESKD, 39 patients (83%) were on hemodialysis (HD) and 7 patients (15%) were on peritoneal dialysis (PD). The probability of survival was significantly higher in patients with NKF compared to ESKD (p = 0.039)(figure 1). Sepsis was the most common cause of death.

Conclusion

Calciphylaxis can occur in patients with normal or abnormal kidney function. Female gender, obesity, multiple, and peripheral lesions were predominant in our cohort. Patients with NKF were younger, which may have contributed to their increased survival compared to ESKD. Sepsis due to secondary infection of necrotic wounds appears to remain the most common cause of death.

Figure 1: Kaplan-Meier curve showing survival in patients with calciphylaxis according to kidney function.