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Abstract: SA-PO196

Metastatic Calcinosis (MC) in Hemodialysis Patients: May Rheopheresis Play a Role?

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical

Author

  • Gernone, Giuseppe, ASL BA Nephrology and Dialysis Unit - S. Maria degli angeli and S. Giacomo Hospitals, Putignano- Monopoli, Bari, Italy
Introduction

MC cutis primarily occurs in CKD because an underlyng defect of Ca/P metabolism that precipitate calcium. Dystrophic Calcinosis, the most common Calcinosis Cutis, frequently in autoimmune connective disease,must be excluded. The management of MC in ESKD is challenging because is based mainly on risk factor control, sometimes with administration of sodium thiosulfate. As data are lack for standardized treatment other approaches are reasonable. LDL-apheresis and rheopheresis successfully treat calciphylaxis but there are no specific indications for MC by ASFA. Aim is to test Double Filtration PlasmaPheresis (DFPP), a rheopheresis technique, to improve the outcome of MC.

Case Description

57-years-old man with Hypertension, Diabetes complicated by neuropathy, fingers amputation and plantar ulcers (left foot) by periferal vasculopathy. Obese. ESKD in HD for over 6 years. Diagnosis of MC, involving face, trunk and limbs, was made. Despite autoimmunity was negative, AVK never used, intralesional corticosteroids were given, calcium-based phosphate binders and Vitamin D analogues were replaced by Sevelamer and calcimimetics,PTH and Ca/P were in the normal range, there was good dialysis adequacy and no increased plasma viscosity: no clinical improvement was attended. A program of 12 treatment (T) of DFPP was started: 3 times/week (T/W) for the first 2, 2 T/W in week 3 and 1 T/W for the following 4. DFPP was conducted by Rheofilter ER-4000. For the first 8 T a single plasma unit (PU) was treated according to the formula: (0.07x weight) x (1-Hct/100); instead 1.5 PU in the remaining 4 T. Complete blood count, albumin, C-Reactive Protein (CRP), LDL-Chol. and Fibrinogen was evaluated. After 8th T there is a remarkable clinical improvement in all body areas, but unexpectedly between the 9th and 10th T there is a flare-up. Protocol was extending up to 24 T: 2 T/W for further 5 weeks, therefore 1 T/W for the last 4 weeks. So after the 16th T there is a remission of skin manifestations. At T0-T12-T24 complete blood count is unchanged, whereas albumin, CRP and LDL-Chol. show significant reduction. Fibrinogen: p=ns

Discussion

DFPP is a promising approach for MC as it leads to clinical remission because specifically improve blood rheology and tissue perfusion with a good safety profile. Larger studies could confirm it as a therapy in patients with MC, but in the meantime, it could help to build a new scientific evidence.