Panchal Sarju, Holtermann Kirstie, Trivedi Namrita, Regunath Hariharan, Yerram Preethi
Department of Internal Medicine, Hospital of University of Pennsylvania, Philadelphia, PA 19146, USA.
Department of Medicine, University of Missouri School of Medicine, Columbia, MO 65212, USA.
Int J Nephrol Renovasc Dis. 2020 Apr 5;13:65-71. doi: 10.2147/IJNRD.S241422. eCollection 2020.
Calciphylaxis is a rare but severe complication mostly affecting patients with end-stage renal disease (ESRD) and is associated with high morbidity and mortality. The natural history, concomitant factors, pathogenesis, and treatment for calciphylaxis remain equivocal.
We conducted a retrospective study on patients diagnosed with calciphylaxis in a tertiary care center between January 1, 2012, and December 31, 2017. We describe demographics, co-morbidities, laboratory parameters, effectiveness of sodium thiosulfate treatment and outcomes.
Of the 30 patients (age 65.6 ± 12.79 years, male:female = 8:22), 23 (76.67%) had ESRD and were either on hemodialysis (15 [65.22%], median duration 22.5 months [range 0.2-96 months]) or peritoneal dialysis (8 [34.78%], duration 29±10 months). Predisposing home medications: 8 (28%) had calcium supplements, 10 (36%) had warfarin, 16 (57%) had vitamin D and 5 (18%) had iron supplements. The median parathyroid hormone (PTH) level was 239.8 pg/mL (range 4.7-2922). Calciphylaxis was found on extremities in 21 (70%) and on torso in 6 (20%) patients. Sodium thiosulfate (STS) was given for treatment in 20 (67%) patients and 3 were cured in <2.25 months. One-year survival for all patients with calciphylaxis was 26% (29% for STS group and 20% for those that did not receive STS) and following any surgical treatment regardless of STS use was 14%.
Retrospective design, absence of a control group and low power.
Calciphylaxis was more common among females with a predilection for extremities over the torso. Elevations in PTH and inflammatory markers were common. Treatment with STS did not show a statistically significant improvement in survival. Those who were cured, were treated with STS up to three months.
钙化防御是一种罕见但严重的并发症，主要影响终末期肾病（ESRD）患者，且与高发病率和死亡率相关。钙化防御的自然病程、伴随因素、发病机制及治疗仍不明确。
我们对2012年1月1日至2017年12月31日期间在一家三级医疗中心被诊断为钙化防御的患者进行了一项回顾性研究。我们描述了人口统计学特征、合并症、实验室参数、硫代硫酸钠治疗的有效性及结局。
30例患者（年龄65.6±12.79岁，男∶女 = 8∶22）中，23例（76.67%）患有ESRD，其中15例（65.22%）接受血液透析（中位时间22.5个月[范围0.2 - 96个月]），8例（34.78%）接受腹膜透析（时间29±10个月）。诱发因素相关的家庭用药情况：8例（28%）服用钙剂，10例（36%）服用华法林，16例（57%）服用维生素D，5例（18%）服用铁剂。甲状旁腺激素（PTH）中位水平为239.8 pg/mL（范围4.7 - 2922）。21例（70%）患者钙化防御出现在四肢，6例（20%）出现在躯干。20例（67%）患者接受硫代硫酸钠（STS）治疗，3例在<2.25个月内治愈。所有钙化防御患者的1年生存率为26%（STS治疗组为29%，未接受STS治疗组为20%），无论是否使用STS，接受任何手术治疗后的1年生存率为14%。
回顾性设计、缺乏对照组且样本量小。
钙化防御在女性中更常见，且四肢受累多于躯干。PTH和炎症标志物升高很常见。STS治疗未显示出生存率有统计学意义的改善。治愈的患者接受STS治疗长达三个月。
