Multi-intervention management of calcific uremic arteriolopathy in 24 patients
| العنوان: | Multi-intervention management of calcific uremic arteriolopathy in 24 patients |
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| المؤلفون: | Claire Harris, Wynnie Lau, Mercedeh Kiaii, Myriam Farah |
| المصدر: | Clinical Kidney Journal |
| بيانات النشر: | Oxford University Press (OUP), 2018. |
| سنة النشر: | 2018 |
| مصطلحات موضوعية: | medicine.medical_specialty, Cinacalcet, medicine.medical_treatment, 030232 urology & nephrology, 030204 cardiovascular system & hematology, Peritoneal dialysis, vitamin K, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, CKD-Mbd, medicine, ESRD, Dialysis, Cause of death, sodium thiosulfate, Transplantation, Calciphylaxis, calciphylaxis, business.industry, Warfarin, calcific uremic arteriolopathy, medicine.disease, Discontinuation, Nephrology, Hemodialysis, business, medicine.drug |
| الوصف: | Background Calcific uremic arteriolopathy (CUA), also known as calciphylaxis, is a rare but life-threatening condition predominately occurring in patients with end-stage renal disease on dialysis. In the absence of randomized clinical trials to guide management, clinicians must rely on observational data. We have previously reported the outcomes of our multi-intervention management in seven patients and now present a larger series of patients with extended follow-up. Methods We performed a retrospective analysis of all patients diagnosed with CUA at a single academic center between 2008 and 2017. We identified 24 patients including 13 hemodialysis, 8 peritoneal dialysis and 3 predialysis Stage 5 chronic kidney disease patients. Results Mean age at diagnosis was 60.5 years (range 35–83) and mean follow-up 30.5 months (range 5 cm). Treatment consisted of intensive hemodialysis (>20 h per week), sodium thiosulfate, wound care, analgesics and discontinuation of trigger medications including warfarin. Hyperbaric oxygen, cinacalcet, bisphosphonates and vitamin K were used in some cases. Overall 1 year mortality was 41% (9/22) and overall mortality at the end of follow-up was 64% (14/24). Cause of death was felt to be attributable to CUA in only four cases (16.7%). Complete or partial resolution of lesions occurred in 17 of 24 patients. One patient had recurrence of CUA 20 months after initial diagnosis. Conclusions Although mortality remains high in this group, direct CUA-attributable mortality is lower than historic reports. We conclude that a multi-intervention approach can be successful in treating a group of patients with severe CUA lesions. |
| تدمد: | 2048-8513 2048-8505 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::a99554ec2a867f811ca159ca33339a81 https://doi.org/10.1093/ckj/sfy007 |
| حقوق: | OPEN |
| رقم الأكسشن: | edsair.doi.dedup.....a99554ec2a867f811ca159ca33339a81 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 20488513 20488505 |
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