Management of Calciphylaxis

1. Eliminate calcium-containing phosphate binders and other oral calcium intake.

2. Avoid excessive calcium-phosphate product.

3. Low or no-calcium dialysate.

4. Increased frequency of dialysis.

5. Parathyroidectomy in cases with severe secondary hyperparathyroidism.

6. Consider IV vitamin D in low doses in nonsurgical candidates with hyperparathyroidism.

7. Hyperbaric oxygen, consider oxygen by nasal cannula.

8. Weight loss in obese patients.

9. Nutritional supplementation to reverse catabolic state in those with precipitous weight loss.

10. Serum glucose control in diabetics.

11. In patients on warfarin, attempt switch to a different anticoagulant.

12. Gentle wound debridement.

13. Consider sodium thiosulfate, bisphosphonates, low-dose tissue plasminogen activator based on anecdotal reports.

The prognosis in calciphylaxis has been poor, with most patients succumbing to sepsis because of extensive cutaneous ulceration. Severe debilitation from co-morbidities also contributes to a poor outcome. While the disease has a grave prognosis, elucidation of the pathways of metabolic control of vascular and tissue calcification give hope for effective management and treatment of these patients in the future.

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