Calciphylaxis: Natural history, risk factor analysis, and outcome

BackgroundCalciphylaxis is characterized by ischemic cutaneous ulceration, high mortality, and ineffective treatment.MethodsWe conducted a retrospective study of 64 patients with calciphylaxis (including 49 dialysis patients age- and sex-matched to 98 dialysis controls).ResultsThe estimated 1-year survival rate of calciphylaxis was 45.8%. Risk factors for calciphylaxis included obesity, liver disease, systemic corticosteroid use, calcium-phosphate product more than 70 mg2/dL2, and serum aluminum greater than 25 ng/mL. Survival rates were similar for 16 patients who received parathyroidectomy and 47 who did not. An estimated 1-year survival rate of 61.6% was observed for 17 patients receiving surgical debridement compared with 27.4% for the 46 who did not (P = .008).LimitationsThe study was limited by its retrospective design and there was no control group for the 15 nondialysis cases.ConclusionsCalciphylaxis is multifactorial and usually fatal. Prevention of calciphylaxis may include correction of risk factors identified in this study. Surgical debridement was associated with improved survival, but parathyroidectomy was not.