Gaisne R, Péré M, Menoyo V, Hourmant M, Larmet-Burgeot D, et al.
BMC nephrology. Date of publication 2020 Feb 26;volume 21(1):63.
1. BMC Nephrol. 2020 Feb 26;21(1):63. doi: 10.1186/s12882-020-01722-y.
Calciphylaxis epidemiology, risk factors, treatment and survival among French
chronic kidney disease patients: a case-control study.
Gaisne R(1)(2), Péré M(3), Menoyo V(4), Hourmant M(5), Larmet-Burgeot D(5)(6).
Author information:
(1)Department of Nephrology and Immunology, Institute of Transplantation Urology
and Nephrology, Centre Hospitalier Universitaire de Nantes, Nantes, France.
raphael.gaisne@chu-nantes.fr.
(2)Service de Néphrologie et Immunologie Clinique, Centre Hospitalier
Universitaire de Nantes, 30, bd Jean Monnet 44093, Nantes, Cedex 01, France.
raphael.gaisne@chu-nantes.fr.
(3)Biostatistician, Direction de la Recherche, Plateforme de Méthodologie et
Biostatistiques, Centre Hospitalier Universitaire de Nantes, Nantes, France.
(4)ECHO Department of Medical Information, Nantes, France.
(5)Department of Nephrology and Immunology, Institute of Transplantation Urology
and Nephrology, Centre Hospitalier Universitaire de Nantes, Nantes, France.
(6)Department of Nephrology, Centre Hospitalier de Saint Nazaire, St Nazaire,
France.
BACKGROUND: Calcific Uremic Arteriolopathy (CUA) is a rare disease, causing
painful skin ulcers in patients with end stage renal disease. Recommendations
for CUA management and treatment are lacking.
METHODS: We conducted a retrospective cohort study on CUA cases identified in
western France, in order to describe its management and outcome in average
clinical practices. Selection was based on the Hayashi diagnosis criteria (2013)
extended to patients with eGFR < 30 mL/min/1.73m2. Dialyzed CUA cases were
compared with 2 controls, matched for age, gender, region of treatment and time
period.
RESULTS: Eighty-nine CUA cases were identified between 2006 and 2016, including
19 non dialyzed and 70 dialyzed patients. Females with obesity (55.1%) were
predominant. Bone mineral disease abnormalities, inflammation and malnutrition
(weight loss, serum albumin decrease) preceded CUA onset for 6 months. The
multimodal treatment strategy included wound care (98.9%), antibiotherapy
(77.5%), discontinuation of Vitamin K antagonists (VKA) (70.8%) and intravenous
sodium thiosulfate (65.2%). 40.4% of the patients died within the year after
lesion onset, mainly under palliative care. Surgical debridement, distal CUA,
localization to the lower limbs and non calcium-based phosphate binders were
associated with better survival. Risks factors of developing CUA among dialysis
patients were obesity, VKA, weight loss, serum albumin decrease or high serum
phosphate in the 6 months before lesion onset.
CONCLUSION: CUA involved mainly obese patients under VKA. Malnutrition and
inflammation preceded the onset of skin lesions and could be warning signs among
dialysis patients at risk.
TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT02854046, registered August
3, 2016.
DOI: 10.1186/s12882-020-01722-y
PMCID: PMC7045437
PMID: 32101140 [Indexed for MEDLINE]
Conflict of interest statement: VM reports receiving grant support from Meditor
and consulting fees from Astellas. The other authors declare that they have no
competing interests.
