Document Detail


Calciphylaxis in patients on hemodialysis: a prevalence study.
MedLine Citation:
PMID:  9426423     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Calciphylaxis is characterized by painful, violaceous, mottled skin lesions (livedo reticularis) that may progress to tissue necrosis, nonhealing ulcers, gangrene, and potentially amputation, sepsis, or death. The prevalence and characteristics of patients who have calciphylaxis need further identification to predict which patients on dialysis may benefit from close monitoring or early surgical intervention. METHODS: All 242 patients undergoing hemodialysis in an outpatient unit were reviewed retrospectively during a 15-month cross-sectional study of the prevalence and characteristics of calciphylaxis. RESULTS: Ten patients (prevalence, 4.1%) had calciphylaxis. Patients with calciphylaxis were significantly younger (49 versus 60 years; p = 0.01), had undergone hemodialysis longer (80 versus 20 months; p < 0.0001), and had higher median serum calcium (9.7 versus 9.2 mg/dl; p = 0.03), phosphate (8.2 versus 5.7 mg/dl; p = 0.001), calcium phosphate product (81.5 versus 52.9; p = 0.0004), parathyroid hormone (1496 versus 138 pg/ml; p < 0.0001), and alkaline phosphatase levels (188 versus 89 IU/L; p = 0.0001). Bone surveys were positive in all 10 patients with calciphylaxis compared with 49 (21%) of the 232 patients without calciphylaxis (p < 0.0001). All patients who underwent parathyroidectomy for calciphylaxis had dramatic healing of the ulcers. CONCLUSIONS: The presence of calciphylaxis is higher among younger patients who had undergone longer periods of hemodialysis. Therefore this group of patients should be monitored aggressively and treated expeditiously for complications of secondary hyperparathyroidism.
Authors:
M Angelis; L L Wong; S A Myers; L M Wong
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Surgery     Volume:  122     ISSN:  0039-6060     ISO Abbreviation:  Surgery     Publication Date:  1997 Dec 
Date Detail:
Created Date:  1998-01-22     Completed Date:  1998-01-22     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0417347     Medline TA:  Surgery     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1083-9; discussion 1089-90     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, John A Burns School of Medicine, University of Hawaii, Honolulu, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Calciphylaxis / epidemiology*,  etiology,  surgery
Cross-Sectional Studies
Female
Humans
Male
Middle Aged
Parathyroidectomy
Prevalence
Renal Dialysis / adverse effects*
Retrospective Studies

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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