Calciphylaxis-as a drug induced adverse event

ABSTRACT

Introduction: Calciphylaxis is a rare but devastating disease with a mortality rate up to 50% in 1 year. It is characterized by profoundly painful ischemic skin lesions and vascular calcification that affects predominantly patients with end stage renal disease. The use of certain medications is an important modifiable risk factor in calciphylaxis and discontinuation of these is a mainstay of treatment.

Areas covered: This review will provide an overview of calciphylaxis and will focus on how certain therapeutic agents can affect the risk of calcification and associated thrombosis, key processes involved in the development of calciphylaxis.

Expert opinion: Calciphylaxis treatment requires a multi-modal approach including prevention, risk factor management, wound care, reperfusion, and use of fibrinolytics and antioxidants. Patients with end stage renal disease represent the most affected population. This population often has multiple medications prescribed, some worth reconsidering before starting or continuing them. When possible, we recommend stopping all potentially contributing medications in patients with calciphylaxis, including warfarin, active vitamin D, calcium supplements, and iron.

Trial registration: ClinicalTrials.gov identifier: NCT02278692.

KEYWORDS:

• Calciphylaxis
• calcium
• cinacalcet
• corticosteroids
• iron
• medications
• phosphate binders
• PTH
• vitamin D
• warfarin

Article highlights

• Calciphylaxis is a rare disease characterized by painful subcutaneous nodules, affecting primarily patients with advanced renal disease.

• Patients on dialysis are complex, have a high burden of medication use and are prone to adverse events from these.

• Multiple medications have been associated with increased risk of calciphylaxis including: calcium, vitamin D, iron, warfarin, steroids.

• We recommend identifying those patients at highest risk of calciphylaxis, considering the use of the CK-MBD equation.

• As part of the treatment of this calciphylaxis we recommend stopping all medications that can contribute to it and considering safer alternatives.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.