[Calciphylaxis: fatal complication of cardiometabolic syndrome in patients with end stage kidney disease].
Calciphylaxis characterized by schemic skin ulceration due to subcutaneous small arterioles calcification, is a rare disease but usually fatal. Disorders of calcium metabolism and vascular calcifications are common in dialysis patients but calciphylaxis prevalence is low in patients with end stage renal disease. So we proposed other emergent factors implicated in calciphylaxis development.


METHODS
We studied retrospective 8 patients who developed calciphylaxis in our service from january 2001 to december 2006.


RESULTS
All patients were female with mean age at diagnosis 68.5+/-6.7 years. All patients were receiving hemodialysis therapy and 6 patients had been receiving hemodialysis less than four months. Six patients had diabetes mellitus type II and all patients were obese (BMI >25 kg/m2). All patients had metabolic syndrome (APTIII) with bad control hypertension and 6 (75%) were receiving anticoagulation therapy with warfarin. Patients didn t have severe alterations of calcium metabolism, all had product calcium-phosphorus <55. All patients developed low blood pressure at the beginning of dialysis treatment (98.3+/-22.7/60+/-18,29 mmHg). 7 patients present proximal lesions in fatty regions like abdomen and thighs. Histopathologic examination reveals calcium deposits in arteriole-sized and small vessels with vascular thrombosis. Prognosis was poor, seven patients died secondary to a sepsis originated in infected cutaneous ulcers.


CONCLUSIONS
calciphylaxis is a disease with poor prognosis and high mortality, without specific treatment actually. Female gender, obesity associated with diabetes mellitus and cardiometabolic syndrome, anticoagulant therapy with warfarin and low blood pressure associated with hemodialysis therapy, are risk factors to develop calciphylaxis, in absence of severe disorders of calcium metabolism. In these patients is important to avoid hypotension episodes during dialysis, dialysis hypotension appears to be an important risk factor who promotes ischemia of subcutaneous adipose tissue.
Verdalles Guzmán
U
U
Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid. ursulaverdalles@yahoo.es
de la Cueva
P
P
Verde
E
E
García de Vinuesa
S
S
Goicoechea
M
M
Mosse
A
A
López Gómez
J M
JM
Luño
J
J
D000368:Aged; D002115:Calciphylaxis / Q000209:etiology* / Q000473:pathology; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*; D024821:Metabolic Syndrome / Q000150:complications*; D008875:Middle Aged; D012189:Retrospective Studies