Successful Treatment of Calciphylaxis in a Young Female With End-Stage Renal Disease on Peritoneal Dialysis With Parathyroidectomy, Intensification of Dialysis, and Sodium Thiosulphate—A Case Report and Literature Review

Calcific uremic arteriolopathy, commonly referred to as “calciphylaxis,” is a rare life-threatening condition observed in patients with chronic kidney disease and end-stage renal disease on dialysis. This results in necrotic, ischemic, tender dermal lesions anywhere in the body, but mainly on the abdominal wall and lower extremities, where subcutaneous tissue is abundant. Histologically, it is defined by calcification in dermal capillaries, arterioles, and subcutaneous adipose tissues. It can occur in all advanced stages of chronic kidney disease as well as end-stage renal disease patients on hemodialysis or peritoneal dialysis. Our case highlights a successful case of calciphylaxis in a young female patient who underwent parathyroidectomy and intensification of peritoneal dialysis regimen along with the infusion of sodium thiosulphate injection resulting in complete resolution of the lesion in 3 months. With limited evidence of treatment options and increased frequency of this condition in a dialysis patient, our case highlights the key aspects of calciphylaxis management in a young end-stage renal disease patient who didn’t need a change of dialysis modality. We also review the risk factors and current practiced management options of this condition in our article.

Download Full-text

Diálise Peritoneal nos Dois Primeiros Anos de Vida: Experiência de uma Unidade de Nefrologia e Transplantação Renal Pediátrica

Acta Médica Portuguesa ◽

10.20344/amp.6913 ◽

2016 ◽

Vol 29 (9) ◽

pp. 525

Author(s):

Sofia Deuchande ◽

Tânia Mano ◽

Cristina Novais ◽

Rute Machado ◽

Rosário Stone ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Peritoneal Dialysis ◽

Renal Transplantation ◽

Kidney Disease ◽

Renal Disease ◽

End Stage Renal Disease ◽

Term Survival ◽

Stage Renal Disease ◽

End Stage

Introduction: Peritoneal dialysis is the dialytic method of choice in chronic end-stage renal disease in children. This study main purposewas to characterize the long-term survival of a pediatric population who began peritoneal dialysis within the first two years of life.Material and Methods: A descriptive and retrospective study was performed in a portuguese nephrology and renal transplantation pediatric unit, between January 1991 and August 2014. End-stage renal disease etiology, mortality, comorbidities and complications of peritoneal dialysis and end-stage renal disease, growth and psychomotor development were evaluated.Results: Twenty children started peritoneal dialysis within the first two years of life. There were six deaths, but no deaths of children with primary chronic kidney disease were registered over the past decade. The 14 living children were characterized; 13 were males. Congenital abnormalities of the kidney and urinary tract were the leading etiology of chronic kidney disease (45%). The average age start of peritoneal dialysis was 6.1 months; six children started before 30 days of life. Peritonitis was the most frequent cause of hospitalization. Ten children were transplanted at an average age of 5.3 years. All of the children who are still in peritoneal dialysis have short stature, but nine of the transplanted have final height within the expected for their mid-parental height target range. Nine (64%)had some type of neurodevelopmental delay.Discussion: Peritoneal dialysis is a technique possible and feasible since birth, as evidenced in the study, as more than half of children successfully started it before 6 months of life. It allows long-term survival until the possibility of renal transplantation despite the associated morbidity, including peritonitis and complications of chronic renal disease. The ten transplanted children improved their growth, recovered from chronic anemia and improved dyslipidemia, compared with the period of dialysis. However, the average waiting time until the renal transplant was 5.3 years higher than other international centers.Conclusion: These data support the use of peritoneal dialysis from birth, but complications and the worst growth reflect the need to develop strategies to optimize care relating to nutrition, growth and development and to reduce pre-transplant time.

Download Full-text

Magnesium in Chronic Kidney Disease: Should We Care?

Blood Purification ◽

10.1159/000485212 ◽

2018 ◽

Vol 45 (1-3) ◽

pp. 173-178 ◽

Cited By ~ 14

Author(s):

Esther R. van de Wal-Visscher ◽

Jeroen P. Kooman ◽

Frank M. van der Sande

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Renal Disease ◽

End Stage Renal Disease ◽

The Body ◽

Cardiac Conduction ◽

Increased Risk ◽

Total Body ◽

Stage Renal Disease ◽

End Stage

Background: Magnesium (Mg) is an essential cation for multiple processes in the body. The kidney plays a major role in regulating the Mg balance. In a healthy individual, total-body Mg content is kept constant by interactions among intestine, bones and the kidneys. Summary: In case of chronic kidney disease (CKD), renal regulatory mechanisms may be insufficient to balance intestinal Mg absorption. Usually Mg remains normal; however, when glomerular filtration rate declines, changes in serum Mg are observed. Patients with end-stage renal disease on dialysis are largely dependent on the dialysate Mg concentration for maintaining serum Mg and Mg homeostasis. A low Mg is associated with several complications such as hypertension, and vascular calcification, and also associated with an increased risk for both cardiovascular disease (CVD) and non-CVD mortality. Severe hypermagnesaemia is known to cause cardiac conduction defects, neuromuscular effects and muscle weakness; a slightly elevated Mg has been suggested to be beneficial in patients with end-stage renal disease. Key Messages: The role of both low and high Mg, in general, but especially in relation to CKD and dialysis patients is discussed.

Download Full-text

Obesity and risk of end-stage renal disease in patients with chronic kidney disease: a cohort study

American Journal of Clinical Nutrition ◽

10.1093/ajcn/nqy200 ◽

2018 ◽

Vol 108 (5) ◽

pp. 1145-1153 ◽

Cited By ~ 2

Author(s):

Ting-Yun Lin ◽

Jia-Sin Liu ◽

Szu-Chun Hung

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Renal Disease ◽

End Stage Renal Disease ◽

The Body ◽

Increased Risk ◽

All Cause Mortality ◽

Stage Renal Disease ◽

End Stage ◽

The Impact

ABSTRACT Background Obesity is a risk factor for de novo chronic kidney disease (CKD) in the general population. Obesity has been increasingly prevalent in patients with CKD and may lead to further progression of pre-existing CKD. However, whether obesity is associated with the development of end-stage renal disease (ESRD) in patients with CKD is not well understood. Objective We investigated the impact of obesity on ESRD (needing chronic dialysis treatment or pre-emptive renal transplantation) or all-cause mortality in patients with moderate to advanced CKD. Design A total of 322 patients with stages 3–5 CKD who were not yet on dialysis were prospectively followed for a median of 4.9 y. Obesity was defined by body mass index (BMI, in kg/m2) ≥30 or body fat percentage (BF%) >25% in men and >35% in women. BF% was assessed with the use of the Body Composition Monitor, a multifrequency bioimpedance spectroscopy device. Results In total, 100 participants progressed to ESRD and 39 participants died. Obesity, whether defined by BMI or BF%, was not associated with a significantly increased risk of ESRD in Cox proportional hazards models that adjusted for age, sex, diabetes mellitus, cardiovascular disease, estimated glomerular filtration rate, urine protein:creatinine ratio, high-sensitivity C-reactive protein, and use of renin-angiotensin-aldosterone system inhibitors or statins, accounting for the competing risk for mortality (subdistribution HR: 1.15; 95% CI: 0.62, 2.14 for BMI-defined obesity and subdistribution HR: 0.84, 95% CI: 0.54, 1.29 for BF%-defined obesity, respectively). Results were similar when BMI and BF% were analyzed as continuous or time-dependent variables. Whereas higher BMI was protective, higher BF% appeared to be associated with increased all-cause mortality. Conclusions Obesity did not confer an increased risk of ESRD in patients with moderate to advanced CKD. This trial was registered at http://www.clinicaltrials.gov as NCT03285074.

Download Full-text

The Continuum of Chronic Kidney Disease and End-Stage Renal Disease: Challenges and Opportunities for Chronic Peritoneal Dialysis in the United States

Peritoneal Dialysis International ◽

10.1177/089686080702700204 ◽

2007 ◽

Vol 27 (2) ◽

pp. 125-130 ◽

Cited By ~ 9

Author(s):

Rajnish Mehrotra

Keyword(s):

Chronic Kidney Disease ◽

Peritoneal Dialysis ◽

Kidney Disease ◽

Renal Disease ◽

End Stage Renal Disease ◽

Chronic Peritoneal Dialysis ◽

The Usa ◽

Stage Renal Disease ◽

End Stage ◽

Esrd Patients

End-stage renal disease (ESRD) patients undergoing renal replacement therapy have a high mortality rate and suffer from considerable morbidity. Degree of nutritional decline, disordered mineral metabolism, and vascular calcification are some of the abnormalities that predict an adverse outcome for ESRD patients. All these abnormalities begin early during the course of chronic kidney disease (CKD), long before the need for maintenance dialysis. Thus, CKD represents a continuum of metabolic and vascular abnormalities. Treatment of these abnormalities early during the course of CKD and a timely initiation of dialysis have the potential of improving patient outcomes. However, the thesis that successful management of these abnormalities will favorably modify the outcomes of dialysis patients remains untested. The proportion of incident USA ESRD patients starting chronic peritoneal dialysis (CPD) has historically been low. Limited physician training and inadequate predialysis patient education appear to underlie the low CPD take-on in the USA. Furthermore, two key changes have occurred in the USA: steep decline in CPD take-on and progressive increase in the use of automated peritoneal dialysis. The decline in CPD take-on has afflicted virtually every subgroup examined and has occurred, paradoxically, when the CPD outcomes in the country have improved. Understanding the reasons for historically low CPD take-on and recent steep declines in utilization may allow the development of plans to reverse these trends.

Download Full-text

Faculty Opinions recommendation of Effect of homocysteine lowering on mortality and vascular disease in advanced chronic kidney disease and end-stage renal disease: a randomized controlled trial.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1091047.552935 ◽

2007 ◽

Author(s):

Rajiv Agarwal

Keyword(s):

Chronic Kidney Disease ◽

Randomized Controlled Trial ◽

Kidney Disease ◽

Renal Disease ◽

End Stage Renal Disease ◽

Controlled Trial ◽

Advanced Chronic Kidney Disease ◽

Randomized Controlled ◽

Stage Renal Disease ◽

End Stage

Download Full-text

Investigation of the Impact of Endodontic Therapy on Survival among Dialysis Patients in Taiwan: A Nationwide Population-Based Cohort Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18010326 ◽

2021 ◽

Vol 18 (1) ◽

pp. 326

Author(s):

Chih-Chien Chiu ◽

Ya-Chieh Chang ◽

Ren-Yeong Huang ◽

Jenq-Shyong Chan ◽

Chi-Hsiang Chung ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Renal Disease ◽

End Stage Renal Disease ◽

Root Canal ◽

Dialysis Patients ◽

Root Canal Therapy ◽

Risk Of Death ◽

Stage Renal Disease ◽

End Stage

Objectives Dental problems occur widely in patients with chronic kidney disease (CKD) and may increase comorbidities. Root canal therapy (RCT) is a common procedure for advanced decayed caries with pulp inflammation and root canals. However, end-stage renal disease (ESRD) patients are considered to have a higher risk of potentially life-threatening infections after treatment and might fail to receive satisfactory dental care such as RCT. We investigated whether appropriate intervention for dental problems had a potential impact among dialysis patients. Design Men and women who began maintenance dialysis (hemodialysis or peritoneal dialysis) between January 1, 2000, and December 31, 2015, in Taiwan (total 12,454 patients) were enrolled in this study. Participants were followed up from the first reported dialysis date to the date of death or end of dialysis by December 31, 2015. Setting Data collection was conducted in Taiwan. Results A total of 2633 and 9821 patients were classified into the RCT and non-RCT groups, respectively. From the data of Taiwan’s National Health Insurance, a total of 5,092,734 teeth received RCT from 2000 to 2015. Then, a total of 12,454 patients were followed within the 16 years, and 4030 patients passed away. The results showed that members of the non-RCT group (34.93%) had a higher mortality rate than those of the RCT group (22.79%; p = 0.001). The multivariate-adjusted hazard ratio for the risk of death was 0.69 (RCT vs. non-RCT; p = 0.001). Conclusions This study suggested that patients who had received RCT had a relatively lower risk of death among dialysis patients. Infectious diseases had a significant role in mortality among dialysis patients with non-RCT. Appropriate interventions for dental problems may increase survival among dialysis patients. Abbreviations: CKD = chronic kidney disease, ESRD = end-stage renal disease, RCT = root canal therapy.

Download Full-text