Dialysis – Transplantation
Kidney International (2001) 60, 324–332; doi:10.1046/j.1523-1755.2001.00803.x
Risk factors and mortality associated with calciphylaxis in end-stage renal disease
A Rauf Mazhar, Richard J Johnson, Daniel Gillen, John C Stivelman, Michael J Ryan, Connie L Davis and Catherine O Stehman-Breen
University of Washington, Division of Nephrology, Seattle, Washington; Baylor College of Medicine, Division of Nephrology, Houston, Texas; Department of Biostatistics, School of Public Health and Community Medicine, University of Washington, Northwest Kidney Centers, and Division of Nephrology, Puget Sound Health Care System, Seattle, Washington, USA
Correspondence: Catherine Stehman-Breen M.D., Division of Nephrology, VA Puget Sound Health Care System, Mailstop 111A, Seattle, Washington 98108, USA. E-mail: cos@u.washington.edu
Received 26 October 2000; Revised 7 February 2001; Accepted 9 February 2001.
Abstract
Risk factors and mortality associated with calciphylaxis in end-stage renal disease.
Background
We conducted a case control study to determine risk factors and mortality associated with calciphylaxis in end-stage renal disease.
Methods
Cases of calciphylaxis diagnosed between December 1989 and January 2000 were identified. Three controls were identified for each hemodialysis patient, with calciphylaxis matched to the date of initiation of hemodialysis. Laboratory data and medication doses were recorded during the 12 months prior to the date of diagnosis and at the time of diagnosis of calciphylaxis. Conditional logistic regression was used to identify risk factors for calciphylaxis. Cox proportional hazards models were used to estimate the risk of death associated with calciphylaxis.
Results
Nineteen cases and 54 controls were identified. Eighteen patients were hemodialysis patients, and one had a functioning renal allograft. Diagnosis was confirmed by skin biopsy in 16 cases. Women were at a sixfold higher risk of developing calciphylaxis (OR = 6.04, 95% CI 1.62 to 22.6, P = 0.007). There was a 21% lower risk of calciphylaxis associated with each 0.1 g/dL increase in the mean serum albumin during the year prior to diagnosis and at the time of diagnosis of calciphylaxis (OR = 0.79, 95% CI, 0.64 to 0.99, P = 0.037, and OR = 0.80, 95% CI, 0.67 to 0.96, P = 0.019, respectively). There was a 3.51-fold increase in the risk of calciphylaxis associated with each mg/dL increase in the mean serum phosphate during the year prior to diagnosis (95% CI, 0.99 to 12.5, P = 0.052). At the time of diagnosis of calciphylaxis, for each 10 IU/L increment in alkaline phosphatase, the risk of calciphylaxis increased by 19% (OR = 1.19, 95% CI, 1.00 to 1.40, P = 0.045). Body mass index, diabetes, blood pressure, aluminum, and higher dosage of erythropoietin and iron dextran were not independent predictors of calciphylaxis. Calciphylaxis independently increased the risk of death by eightfold (OR = 8.58, 95% CI, 3.26 to 22.6, P < 0.001).
Conclusions
Female gender, hyperphosphatemia, high alkaline phosphatase, and low serum albumin are risk factors for calciphylaxis. Calciphylaxis is associated with a very high mortality.
Keywords:
hyperphosphatemia, alkaline phosphatase and calciphylaxis, serum albumin and calciphylaxix, death and calciphylaxis, skin lesions and mortality
