title: Hyperbaric oxygen in the treatment of calciphylaxis: A case series and literature review.
abstract: OBJECTIVE
  Calcific uraemic arteriolopathy (CUA) or calciphylaxis is most commonly seen in end-stage renal disease and is associated with significant morbidity and mortality. The aim of this study was to determine whether hyperbaric oxygen therapy (HBOT) is effective in healing calciphylaxis lesions and to determine if there are any patient factors that can predict wound healing and patient survival.
  
  
  METHODS
  We identified by retrospective review all cases of CUA referred to our institution for treatment with HBOT. We documented the clinical and biochemical parameters of this patient population, the size and distribution of the lesions as well as wound outcomes and patient survival following treatment.
  
  
  RESULTS
  A total 46 patients were identified with CUA associated with renal failure. Of the 46 patients, only 34 received a full course of HBOT. The balance was deemed unsuitable for treatment or was unable to tolerate treatment and was palliated. Of the 34 patients that received a full course of HBOT, 58% showed improvement in their wound scores, with more than half of these patients having complete healing of their wounds. The balance did not benefit from the therapy and had a very poor prognosis. Those that benefited from HBOT survived on average for more than 3 years. The only factor significantly associated with improved wound healing and survival was diabetes.
  
  
  CONCLUSIONS
  This retrospective analysis suggests a role for HBOT in the treatment of CUA with more than half of the treated patients benefiting and surviving for an average of more than 3 years.
authors.affiliation: Department Renal Medicine, Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Jennifer
authors.initials: J
authors.lastname: An
authors.affiliation: Department Intensive Care and Hyperbaric Medicine, Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Bridget
authors.initials: B
authors.lastname: Devaney
authors.affiliation: Department Renal Medicine, Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Khai Yang
authors.initials: KY
authors.lastname: Ooi
authors.affiliation: Department Renal Medicine, Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Sharon
authors.initials: S
authors.lastname: Ford
authors.affiliation: Department Intensive Care and Hyperbaric Medicine, Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Geoff
authors.initials: G
authors.lastname: Frawley
authors.affiliation: Department Renal Medicine, Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Solomon
authors.initials: S
authors.lastname: Menahem
mesh_terms: D002115:Calciphylaxis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D006931:Hyperbaric Oxygenation; D007676:Kidney Failure, Chronic / Q000150:complications; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D014945:Wound Healing
keywords: calciphylaxis; calcium phosphate product; end-stage kidney disease; hyperbaric oxygen; hyperparathyroidism