Therapy for calciphylaxis: an outcome analysis.
BACKGROUND
Violaceous skin lesions that progress to nonhealing ulcerations and gangrene characterize calciphylaxis. These lesions, which are associated with secondary hyperparathyroidism, are resistant to medical therapy and may lead to amputation, uncontrollable sepsis, and death.


METHODS
In this retrospective analysis, patient, disease, and treatment variables were obtained from the patients' medical records. Paired t-tests, chi-square analysis, and two-tailed Fisher's exact tests compared variables. Survival curves were generated using the Kaplan-Meier method; the log-rank test determined survival differences.


RESULTS
From 1993 to 2001, 35 patients were treated; 26 (74%) were female and 20 (57%) were African-American. The cause of the renal failure was hypertension in 37% and diabetes mellitus in 26%. Twenty-three patients (66%) underwent a parathyroid resection involving 4 glands and autotransplantation in 12, 3(1/2) glands in 7, and <3(1/2) glands in 4. Median follow-up was 26 months (range 2 to 90 months). Surgical patients showed improvement in serum calcium, phosphate, and parathyroid hormone values (P<.05) and had a longer median overall survival (80 months) than nonsurgical patients (35 months) (P<.001).


CONCLUSIONS
Parathyroid resection for calciphylaxis reduces serum calcium, phosphate, and parathyroid hormone values and improves clinical response and overall survival.
Arch-Ferrer
Jorge E
JE
Department of Surgery, University of Alabama at Birmingham, 1530 3rd Avenue South, Birmingham, AL 35294, USA.
Beenken
Samuel W
SW
Rue
Loring W
LW
Bland
Kirby I
KI
Diethelm
Arnold G
AG
D000328:Adult; D000368:Aged; D002115:Calciphylaxis / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy*; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000150:complications / Q000628:therapy; D006973:Hypertension / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000150:complications; D008297:Male; D008875:Middle Aged; D016105:Parathyroidectomy / Q000379:methods; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome