Multidisciplinary management of calciphylaxis: a series of 5 patients at a single facility

Anticoagulant-associated calciphylaxis: analysis of USFDA adverse event report system and clinical feature analysis of reported cases

BACKGROUND

Calciphylaxis is a serious, potentially fatal condition resulting in pathological calcification of soft tissues. While associated with chronic kidney disease, data regarding anticoagulant involvement remain limited.

RESEARCH DESIGN AND METHODS

The United States Food and Drug Administration Adverse Event Reporting System (USFDA AERS) database was searched to identify calciphylaxis reports linked to anticoagulants from 2004 to 2024. Disproportionality analyses compared reporting rates versus usage. Literature was reviewed to extract calciphylaxis case details with specific anticoagulants.

RESULTS

Disproportionality signals were observed between calciphylaxis and warfarin, heparin, and apixaban from 471 unique reports. Literature review confirmed an association between warfarin and calciphylaxis based on 54 cases from 48 reports. Risk factors for warfarin-associated calciphylaxis included older age, female sex, and longer duration. Approximately two-thirds responded to sodium thiosulfate, bisphosphonates, or hyperbaric oxygen therapy.

CONCLUSION

This evaluation characterized calciphylaxis safety signals from pharmacovigilance data and literature review. Warfarin emerged as the most strongly associat.ed based on both sources. While limitations preclude causality determination, findings warrant attention regarding warfarin's calciphylaxis risk profile, especially in higher-risk populations. Additional research is needed, including controlled trials, to validate this relationship and optimize management.

Penile Calciphylaxis Obscured by Phimosis in an End-Stage Renal Disease Patient: A Case Report

Penile calciphylaxis is a rare and severe complication primarily observed in patients with end-stage renal disease (ESRD) undergoing dialysis. A 50-year-old man presented with severe penile pain and phimosis. He had a history of hypertension and diabetes mellitus for 10 years, complicated by ESRD and was awaiting a cadaveric kidney transplant. He was on cinacalcet therapy for tertiary hyperparathyroidism. The patient underwent circumcision at which discolouration and necrotic patches involving the glans penis were noted. The histological findings were consistent with calciphylaxis and suppurative inflammation. However, due to persistent severe pain and progressive gangrene, a partial penectomy was performed. This report demonstrates the importance of consideration of calciphylaxis in patients with ESRD when presenting with penile pain, even phimosis.

Intravenous Sodium Thiosulphate for Calciphylaxis of Chronic Kidney Disease: A Systematic Review and Meta-analysis

Importance

Calciphylaxis is a rare disease with high mortality mainly involving patients with chronic kidney disease (CKD). Sodium thiosulphate (STS) has been used as an off-label therapeutic in calciphylaxis, but there is a lack of clinical trials and studies that demonstrate its effect compared with those without STS treatment.

Objective

To perform a meta-analysis of the cohort studies that provided data comparing outcomes among patients with calciphylaxis treated with and without intravenous STS.

Data Sources

PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov were searched using relevant terms and synonyms including sodium thiosulphate and calci* without language restriction.

Study Selection

The initial search was for cohort studies published before August 31, 2021, that included adult patients diagnosed with CKD experiencing calciphylaxis and could provide a comparison between patients treated with and without intravenous STS. Studies were excluded if they reported outcomes only from nonintravenous administration of STS or if the outcomes for CKD patients were not provided.

Data Extraction and Synthesis

Random-effects models were performed. The Egger test was used to measure publication bias. Heterogeneity was assessed using the I2 test.

Main Outcomes and Measures

Skin lesion improvement and survival, synthesized as ratio data by a random-effects empirical Bayes model.

Results

Among the 5601 publications retrieved from the targeted databases, 19 retrospective cohort studies including 422 patients (mean age, 57 years; 37.3% male) met the eligibility criteria. No difference was observed in skin lesion improvement (12 studies with 110 patients; risk ratio, 1.23; 95% CI, 0.85-1.78) between the STS and the comparator groups. No difference was noted for the risk of death (15 studies with 158 patients; risk ratio, 0.88; 95% CI, 0.70-1.10) and overall survival using time-to-event data (3 studies with 269 participants; hazard ratio, 0.82; 95% CI, 0.57-1.18). In meta-regression, lesion improvement associated with STS negatively correlated with publication year, implying that recent studies are more likely to report a null association compared with past studies (coefficient = -0.14; P = .008).

Conclusions and Relevance

Intravenous STS was not associated with skin lesion improvement or survival benefit in patients with CKD experiencing calciphylaxis. Future investigations are warranted to examine the efficacy and safety of therapies for patients with calciphylaxis.

Warfarin-Induced Calcification: Potential Prevention and Treatment Strategies

Warfarin is clinically used as the first choice for long-term anticoagulant therapy, and for the prevention of thromboembolic events. However, when used at low doses in the long term or high doses in the short term, warfarin treatment may result in tissue calcifications-such as calcifications in the coronary arteries, peripheral vascular system, blood vessels of patients with atrial fibrillation and chronic kidney disease, and vascular valves-and atherosclerotic plaque calcification. These warfarin-induced calcifications may affect cardiovascular function and exacerbate diseases such as diabetes and hypertension. Studies have shown that quercetin, osteoprotegerin, sclerosin, and sodium thiosulfate may alleviate these effects by interfering in the Wnt/ β -catenin, TG2/ β -catenin, Bone Morphogenetic Protein 2 (BMP2), and Eicosapentaenoic Acid/Matrix Metallopeptidase-9 (EPA/MMP-9) pathways, respectively. Nevertheless, the mechanism underlying warfarin-induced calcification remains unknown. Therefore, the question as to how to effectively attenuate the calcification induced by warfarin and ensure its anticoagulant effect remains an urgent clinical problem that needs to be resolved. To utilize warfarin rationally and to effectively attenuate the calcifications, we focused on the clinical phenomena, molecular mechanisms, and potential strategies to prevent calcification. Highlighting these aspects could provide new insights into the effective utilization of warfarin and the reduction of its associated calcification effects.

Penile calciphylaxis in patients with end-stage kidney disease undergoing dialysis: invasive treatment and pain management

INTRODUCTION

Penile calciphylaxis is rarely reported in dialysis patients.

METHODS

We experienced cases of dialysis patients who had penile calciphylaxis between 2003 and 2020.

RESULTS

Seven patients undergoing dialysis were treated for penile necrosis (hemodialysis [HD], 5; peritoneal dialysis [PD], 1; hybrid therapy comprising PD and HD, 1). Their mean age was 62.8 years and their mean dialysis vintage 116.1 months. All had severe penile pain and were clinically diagnosed with calciphylaxis. Four received partial penectomy and three received percutaneous transluminal angioplasty (PTA) due to rapid aggravation. The number of analgesia types and the critical-care pain observation tool score significantly decreased after invasive treatment (both, P = 0.008). The 90-day and 1-year survival rates after onset were 85.7% and 57.1%, respectively.

CONCLUSION

In dialysis patients, penile calciphylaxis has poor prognosis; however, invasive treatments for pain management are effective. PTA may be beneficial in dialysis patients in poor condition. This article is protected by copyright. All rights reserved.

Penile calciphylaxis diagnosis and treatment challenges a case report

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Rarity of this presentation.

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Controversies on treatment.

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Controversies about diagnosis.

Introduction

Painful tip penile ischemic lesion that varies from ulceration to dry gangrene which is calcified in a patient with ESRD on chronic dialysis is a seriously complicated disease due to microvascular disease of subcutaneous and adipose tissue.

Case presentation

72 gentleman who is on chronic dialysis for the last 8 years because of ESRD, In which he developed many vascular disease and amputation done for him presented with spreading black painful areas at the tip of the glans for which conservative treatment took place for about month.

Discussion

The diagnosis and management of this rare disease still unclear. Diagnosis mostly clinical, treatment conservative versus surgical.

Conclusion

Controversies of for penile Calciphylaxis diagnosis and treatment for its rarity, high mortality rate, and as its part of systematic disease treatment till know individualized according to patient status and extent of the necrotic area.