Clinical characteristics and treatment modalities in uremic and non uremic calciphylaxis - a dermatological single-center experience

Figures & data

Figure 1. Deep skin biopsy of the left lower leg of a 79 year-old male patient with non-uremic calciphylaxis. The von Kossa stain demonstrates vascular perieccrine calcification (arrow), calcification of a subcutaneous artery and adjacent capillaries (asterisk) as well as diffuse calcification of fibers in the deep dermis.

Table 1. Epidemiological characteristics of all calciphylaxis cases.

Clinical characteristics of CP patients
	CUA(n = 39)	NUC(n = 21)
Age(mean)	76 years	70 years
Gender(%)
Males	49	67
Females	51	33
Location of lesion(%)
Lower legs	85	95
Thigh	10	0
Lower arm	3	5
Knee	3	0
Affected side of body(%)
Right	44	43
Left	31	33
Bilateral	26	24
Number of lesions(%)
Single	74	67
Multiple	26	33
Survival(%)
Alive	72	95
Dead	28	5
Median Survival(months)
	60	57

Figure 2. Overview of comorbidities of CUA vs. NUC patients at the time of diagnosis PAD = peripheral artery disease.

*Significant (p < 0.05) difference between the NUC and CUA cohorts.

Figure 3. Overview of medication history of CUA vs. NUC patients at the time of diagnosis.

*Significant (p < 0.05) difference between the NUC and CUA cohorts.

Table 2. Overview of laboratory abnormalities in CUA vs. NUC patients. Normal ranges for selected parameters: serum calcium 2.2 –2.65 mmol/l, serum phosphate 0.81 – 1.45 mmol/l, calcium-phosphorus-product < 4.40 mmol²/l² and serum albumin 35—55 g/l.

	NUC			CUA
	Number of patients^a	Laboratory values(%)		Number of patients^a	Laboratory values(%)
Laboratory parameters	n	above the normal range	below the normal range	N	above the normal range	below the normal range
Creatinine	n = 21	5	0	n = 39	95	0
eGFR	n = 21	0	5	n = 39	0	95
Calcium	n = 21	5	14	n = 39	3	41
Phosphorus **	n = 17	0	6	n = 38	55	3
Calcium-Phosphorus-Product	n = 15	0	0	n = 36	11	0
Parathyroid hormone**	n = 15	20	7	n = 33	73	3
Albumin**	n = 19	0	21	n = 30	0	57
Glucose	n = 19	42	5	n = 35	49	0
Hemoglobin**	n = 21	5	33	n = 39	0	87
C-reactive protein	n = 21	86	0	n = 38	97	0
Vitamin D	n = 9	0	89	n = 19	0	79
TSH	n = 9	0	0	n = 30	13	0
Iron	n = 9	0	11	n = 25	4	60
Ferritin	n = 8	25	13	n = 24	21	4
INR	n = 19	26	0	n = 39	41	0
HbA1c	n = 17	24	0	n = 27	56	0
Alkaline Phosphatase	n = 20	25	0	n = 37	43	3
AST/ALT	n = 21	24	0	n = 39	0	0
GGT	n = 21	57	0	n = 39	72	0
Triglycerides**	n = 11	0	0	n = 29	31	0
LDL Cholesterol	n = 6	83	0	n = 27	59	0
Cryoglobulins	n = 10	0	0	n = 15	0	0

^a Owing to the lack of laboratory data for some cases, the total number of patients for each laboratory parameter may vary.

**Significant (p < 0.05) difference between the NUC and CUA cohorts.

Table 3. Systemic treatment in patients with NUC and CUA.

	Number of patients treated *
Treatment	NUC	CUA
Any systemic therapy	8 (38 %)	39 (100 %)
Sodium thiosulfate	n.a.	14 (38 %)
Cinacalcet	n.a.	11 (28 %)
Sevelamer carbonate (phosphate binder)	n.a.	6 (15 %)
Lanthanum carbonate (phosphate binder)	n.a.	5 (13 %)
Biphosphonates	2 (10 %)	2 (5 %)
Vitamin K supplementation	n.a.	3 (8%)
Acetylsalicylic acid^a (as a therapeutic intervention)	6 (29 %)	n.a.

^a some patients received more than one systemic treatment during course of disease.

** for rationale of this therapeutic invention, see results section.

n.a. - not applied in these patients.

Data availability statement

The abstract contains 237 words, and the major text of the article contains 3261 words, three tables, three figures, and 61 references.