Survival, Risk Factors, and Effect of Treatment in 101 Patients With Calciphylaxis
Abstract Objective To report on the survival and the associations of treatments upon survival of patients with calciphylaxis seen at a single center. Patients and Methods Using the International Classification of Diseases, Ninth Revision diagnosis code of 275.49 and the keyword “calciphylaxis” in th...
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| Veröffentlicht in: | Mayo Clinic proceedings 2016-10, Vol.91 (10), p.1384-1394 |
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| creator | McCarthy, James T., MD el-Azhary, Rokea A., MD, PhD Patzelt, Michelle T., MD Weaver, Amy L., MS Albright, Robert C., DO Bridges, Alina D., DO Claus, Paul L., MD Davis, Mark D.P., MD Dillon, John J., MD El-Zoghby, Ziad M., MD Hickson, LaTonya J., MD Kumar, Rajiv, MD McBane, Robert D., MD McCarthy-Fruin, Kathleen A.M., BA McEvoy, Marian T., MD Pittelkow, Mark R., MD Wetter, David A., MD Williams, Amy W., MD |
| description | Abstract Objective To report on the survival and the associations of treatments upon survival of patients with calciphylaxis seen at a single center. Patients and Methods Using the International Classification of Diseases, Ninth Revision diagnosis code of 275.49 and the keyword “calciphylaxis” in the dismissal narrative, we retrospectively identified 101 patients with calciphylaxis seen at our institution between January 1, 1999, through September 20, 2014, using a predefined, consensus-developed classification scheme. Results The average age of patients was 60 years: 81 (80.2%) were women; 68 (68.0%) were obese; 19 (18.8%) had stage 0 to 2 chronic kidney disease (CKD), 19 (18.9%) had stage 3 or 4 CKD; 63 (62.4%) had stage 5 or 5D (dialysis) CKD. Seventy-five patients died during follow-up. Six-month survival was 57%. Lack of surgical debridement was associated with insignificantly lower 6-month survival (hazard ratio [HR]=1.99; 95% CI, 0.96-4.15; P =.07) and significantly poorer survival for the entire duration of follow-up (HR=1.98; 95% CI, 1.15-3.41; P =.01), which was most pronounced in stage 5 or 5D CKD (HR=1.91; 95% CI, 1.03-3.56; P =.04). Among patients with stage 5/5D CKD, subtotal parathyroidectomy (performed only in patients with hyperparathyroidism) was associated with better 6-month (HR=0.12; 95% CI, 0.02-0.90; P =.04) and overall survival (HR= 0.37; 95% CI, 0.15-0.87; P =.02). Conclusion Calciphylaxis is associated with a high mortality rate. Significantly effective treatments included surgical debridement and subtotal parathyroidectomy in patients with stage 5/5D CKD with hyperparathyroidism. Treatments with tissue-plasminogen activator, sodium thiosulfate, and hyperbaric oxygen therapy were not associated with higher mortality. |
| doi_str_mv | 10.1016/j.mayocp.2016.06.025 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_proqu</sourceid><recordid>TN_cdi_proquest_miscellaneous_1835372757</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A470463322</galeid><els_id>S0025619616303676</els_id><sourcerecordid>A470463322</sourcerecordid><originalsourceid>FETCH-LOGICAL-c515t-9cdef4c9abdb4ff3c6468d31e2aa08f6d25f3a1cebcd88106960809d3b3bc22b3</originalsourceid><addsrcrecordid>eNqFkltrFDEUxwdR7Lb6DUQCgvjQWXOZycy8CGVpVSgobcXHkElO3Gwzk22SWdxv3yxTb32RHAjn8DsXzv8UxSuClwQT_n6zHOTeq-2SZm-Js9H6SbEgXUXLuq7402KBc6jkpONHxXGMG4xx03XV8-KINg2hnDWL4up6Cju7k-4UXdl4iy6kSj7EUyRHjc6NAZWQN-gmgEwDjAnZEeX26KtMNrsRfbdpjVbSKbtd7538aeOL4pmRLsLLh_-k-HZxfrP6VF5--fh5dXZZqprUqeyUBlOpTva6r4xhile81YwAlRK3hmtaGyaJgl7ptiWYdxy3uNOsZ72itGcnxbu57jb4uwliEoONCpyTI_gpCtKymjW0qZuMvnmEbvwUxjxdpignmDUtztRypn5IB8KOxqcgVX4aBqv8CMbm-FnV4IozRmlOePtXwhqkS-vo3ZSsH-O_YDWDKvgYAxixDXaQYS8IFgc1xUbMaoqDmgJno3VOe_0w9tQPoH8n_ZIvAx9mAPKedxaCiCrLokDbkJUT2tv_dXhcQDk7WiXdLewh_tmSiFRgcX24qMNBEc4w4w1n9--1xJo</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1826103780</pqid></control><display><type>article</type><title>Survival, Risk Factors, and Effect of Treatment in 101 Patients With Calciphylaxis</title><source>MEDLINE</source><source>Alma/SFX Local Collection</source><creator>McCarthy, James T., MD ; el-Azhary, Rokea A., MD, PhD ; Patzelt, Michelle T., MD ; Weaver, Amy L., MS ; Albright, Robert C., DO ; Bridges, Alina D., DO ; Claus, Paul L., MD ; Davis, Mark D.P., MD ; Dillon, John J., MD ; El-Zoghby, Ziad M., MD ; Hickson, LaTonya J., MD ; Kumar, Rajiv, MD ; McBane, Robert D., MD ; McCarthy-Fruin, Kathleen A.M., BA ; McEvoy, Marian T., MD ; Pittelkow, Mark R., MD ; Wetter, David A., MD ; Williams, Amy W., MD</creator><creatorcontrib>McCarthy, James T., MD ; el-Azhary, Rokea A., MD, PhD ; Patzelt, Michelle T., MD ; Weaver, Amy L., MS ; Albright, Robert C., DO ; Bridges, Alina D., DO ; Claus, Paul L., MD ; Davis, Mark D.P., MD ; Dillon, John J., MD ; El-Zoghby, Ziad M., MD ; Hickson, LaTonya J., MD ; Kumar, Rajiv, MD ; McBane, Robert D., MD ; McCarthy-Fruin, Kathleen A.M., BA ; McEvoy, Marian T., MD ; Pittelkow, Mark R., MD ; Wetter, David A., MD ; Williams, Amy W., MD</creatorcontrib><description>Abstract Objective To report on the survival and the associations of treatments upon survival of patients with calciphylaxis seen at a single center. Patients and Methods Using the International Classification of Diseases, Ninth Revision diagnosis code of 275.49 and the keyword “calciphylaxis” in the dismissal narrative, we retrospectively identified 101 patients with calciphylaxis seen at our institution between January 1, 1999, through September 20, 2014, using a predefined, consensus-developed classification scheme. Results The average age of patients was 60 years: 81 (80.2%) were women; 68 (68.0%) were obese; 19 (18.8%) had stage 0 to 2 chronic kidney disease (CKD), 19 (18.9%) had stage 3 or 4 CKD; 63 (62.4%) had stage 5 or 5D (dialysis) CKD. Seventy-five patients died during follow-up. Six-month survival was 57%. Lack of surgical debridement was associated with insignificantly lower 6-month survival (hazard ratio [HR]=1.99; 95% CI, 0.96-4.15; P =.07) and significantly poorer survival for the entire duration of follow-up (HR=1.98; 95% CI, 1.15-3.41; P =.01), which was most pronounced in stage 5 or 5D CKD (HR=1.91; 95% CI, 1.03-3.56; P =.04). Among patients with stage 5/5D CKD, subtotal parathyroidectomy (performed only in patients with hyperparathyroidism) was associated with better 6-month (HR=0.12; 95% CI, 0.02-0.90; P =.04) and overall survival (HR= 0.37; 95% CI, 0.15-0.87; P =.02). Conclusion Calciphylaxis is associated with a high mortality rate. Significantly effective treatments included surgical debridement and subtotal parathyroidectomy in patients with stage 5/5D CKD with hyperparathyroidism. Treatments with tissue-plasminogen activator, sodium thiosulfate, and hyperbaric oxygen therapy were not associated with higher mortality.</description><identifier>ISSN: 0025-6196</identifier><identifier>EISSN: 1942-5546</identifier><identifier>DOI: 10.1016/j.mayocp.2016.06.025</identifier><identifier>PMID: 27712637</identifier><identifier>CODEN: MACPAJ</identifier><language>eng</language><publisher>England: Elsevier Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Analysis ; Calcification ; Calciphylaxis - complications ; Calciphylaxis - mortality ; Calciphylaxis - therapy ; Care and treatment ; Chronic kidney failure ; Debridement ; Diabetes Mellitus ; Female ; Glomerular Filtration Rate ; Humans ; Hyperbaric Oxygenation ; Hyperparathyroidism - etiology ; Hyperparathyroidism - surgery ; Hypertension - complications ; Internal Medicine ; Male ; Middle Aged ; Minnesota - epidemiology ; Neoplasms - complications ; Obesity - complications ; Parathyroidectomy ; Patient outcomes ; Renal Insufficiency, Chronic - classification ; Renal Insufficiency, Chronic - complications ; Retrospective Studies ; Risk Factors ; Severity of Illness Index ; Thiosulfates - therapeutic use ; Tissue Plasminogen Activator - therapeutic use ; Treatment outcome ; Young Adult</subject><ispartof>Mayo Clinic proceedings, 2016-10, Vol.91 (10), p.1384-1394</ispartof><rights>Mayo Foundation for Medical Education and Research</rights><rights>2016 Mayo Foundation for Medical Education and Research</rights><rights>Copyright © 2016 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.</rights><rights>COPYRIGHT 2016 Frontline Medical Communications Inc.</rights><rights>Copyright Mayo Foundation for Medical Education and Research Oct 2016</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c515t-9cdef4c9abdb4ff3c6468d31e2aa08f6d25f3a1cebcd88106960809d3b3bc22b3</citedby><cites>FETCH-LOGICAL-c515t-9cdef4c9abdb4ff3c6468d31e2aa08f6d25f3a1cebcd88106960809d3b3bc22b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27712637$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>McCarthy, James T., MD</creatorcontrib><creatorcontrib>el-Azhary, Rokea A., MD, PhD</creatorcontrib><creatorcontrib>Patzelt, Michelle T., MD</creatorcontrib><creatorcontrib>Weaver, Amy L., MS</creatorcontrib><creatorcontrib>Albright, Robert C., DO</creatorcontrib><creatorcontrib>Bridges, Alina D., DO</creatorcontrib><creatorcontrib>Claus, Paul L., MD</creatorcontrib><creatorcontrib>Davis, Mark D.P., MD</creatorcontrib><creatorcontrib>Dillon, John J., MD</creatorcontrib><creatorcontrib>El-Zoghby, Ziad M., MD</creatorcontrib><creatorcontrib>Hickson, LaTonya J., MD</creatorcontrib><creatorcontrib>Kumar, Rajiv, MD</creatorcontrib><creatorcontrib>McBane, Robert D., MD</creatorcontrib><creatorcontrib>McCarthy-Fruin, Kathleen A.M., BA</creatorcontrib><creatorcontrib>McEvoy, Marian T., MD</creatorcontrib><creatorcontrib>Pittelkow, Mark R., MD</creatorcontrib><creatorcontrib>Wetter, David A., MD</creatorcontrib><creatorcontrib>Williams, Amy W., MD</creatorcontrib><title>Survival, Risk Factors, and Effect of Treatment in 101 Patients With Calciphylaxis</title><title>Mayo Clinic proceedings</title><addtitle>Mayo Clin Proc</addtitle><description>Abstract Objective To report on the survival and the associations of treatments upon survival of patients with calciphylaxis seen at a single center. Patients and Methods Using the International Classification of Diseases, Ninth Revision diagnosis code of 275.49 and the keyword “calciphylaxis” in the dismissal narrative, we retrospectively identified 101 patients with calciphylaxis seen at our institution between January 1, 1999, through September 20, 2014, using a predefined, consensus-developed classification scheme. Results The average age of patients was 60 years: 81 (80.2%) were women; 68 (68.0%) were obese; 19 (18.8%) had stage 0 to 2 chronic kidney disease (CKD), 19 (18.9%) had stage 3 or 4 CKD; 63 (62.4%) had stage 5 or 5D (dialysis) CKD. Seventy-five patients died during follow-up. Six-month survival was 57%. Lack of surgical debridement was associated with insignificantly lower 6-month survival (hazard ratio [HR]=1.99; 95% CI, 0.96-4.15; P =.07) and significantly poorer survival for the entire duration of follow-up (HR=1.98; 95% CI, 1.15-3.41; P =.01), which was most pronounced in stage 5 or 5D CKD (HR=1.91; 95% CI, 1.03-3.56; P =.04). Among patients with stage 5/5D CKD, subtotal parathyroidectomy (performed only in patients with hyperparathyroidism) was associated with better 6-month (HR=0.12; 95% CI, 0.02-0.90; P =.04) and overall survival (HR= 0.37; 95% CI, 0.15-0.87; P =.02). Conclusion Calciphylaxis is associated with a high mortality rate. Significantly effective treatments included surgical debridement and subtotal parathyroidectomy in patients with stage 5/5D CKD with hyperparathyroidism. Treatments with tissue-plasminogen activator, sodium thiosulfate, and hyperbaric oxygen therapy were not associated with higher mortality.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Analysis</subject><subject>Calcification</subject><subject>Calciphylaxis - complications</subject><subject>Calciphylaxis - mortality</subject><subject>Calciphylaxis - therapy</subject><subject>Care and treatment</subject><subject>Chronic kidney failure</subject><subject>Debridement</subject><subject>Diabetes Mellitus</subject><subject>Female</subject><subject>Glomerular Filtration Rate</subject><subject>Humans</subject><subject>Hyperbaric Oxygenation</subject><subject>Hyperparathyroidism - etiology</subject><subject>Hyperparathyroidism - surgery</subject><subject>Hypertension - complications</subject><subject>Internal Medicine</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Minnesota - epidemiology</subject><subject>Neoplasms - complications</subject><subject>Obesity - complications</subject><subject>Parathyroidectomy</subject><subject>Patient outcomes</subject><subject>Renal Insufficiency, Chronic - classification</subject><subject>Renal Insufficiency, Chronic - complications</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Severity of Illness Index</subject><subject>Thiosulfates - therapeutic use</subject><subject>Tissue Plasminogen Activator - therapeutic use</subject><subject>Treatment outcome</subject><subject>Young Adult</subject><issn>0025-6196</issn><issn>1942-5546</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BEC</sourceid><sourceid>BENPR</sourceid><recordid>eNqFkltrFDEUxwdR7Lb6DUQCgvjQWXOZycy8CGVpVSgobcXHkElO3Gwzk22SWdxv3yxTb32RHAjn8DsXzv8UxSuClwQT_n6zHOTeq-2SZm-Js9H6SbEgXUXLuq7402KBc6jkpONHxXGMG4xx03XV8-KINg2hnDWL4up6Cju7k-4UXdl4iy6kSj7EUyRHjc6NAZWQN-gmgEwDjAnZEeX26KtMNrsRfbdpjVbSKbtd7538aeOL4pmRLsLLh_-k-HZxfrP6VF5--fh5dXZZqprUqeyUBlOpTva6r4xhile81YwAlRK3hmtaGyaJgl7ptiWYdxy3uNOsZ72itGcnxbu57jb4uwliEoONCpyTI_gpCtKymjW0qZuMvnmEbvwUxjxdpignmDUtztRypn5IB8KOxqcgVX4aBqv8CMbm-FnV4IozRmlOePtXwhqkS-vo3ZSsH-O_YDWDKvgYAxixDXaQYS8IFgc1xUbMaoqDmgJno3VOe_0w9tQPoH8n_ZIvAx9mAPKedxaCiCrLokDbkJUT2tv_dXhcQDk7WiXdLewh_tmSiFRgcX24qMNBEc4w4w1n9--1xJo</recordid><startdate>20161001</startdate><enddate>20161001</enddate><creator>McCarthy, James T., MD</creator><creator>el-Azhary, Rokea A., MD, PhD</creator><creator>Patzelt, Michelle T., MD</creator><creator>Weaver, Amy L., MS</creator><creator>Albright, Robert C., DO</creator><creator>Bridges, Alina D., DO</creator><creator>Claus, Paul L., MD</creator><creator>Davis, Mark D.P., MD</creator><creator>Dillon, John J., MD</creator><creator>El-Zoghby, Ziad M., MD</creator><creator>Hickson, LaTonya J., MD</creator><creator>Kumar, Rajiv, MD</creator><creator>McBane, Robert D., MD</creator><creator>McCarthy-Fruin, Kathleen A.M., BA</creator><creator>McEvoy, Marian T., MD</creator><creator>Pittelkow, Mark R., MD</creator><creator>Wetter, David A., MD</creator><creator>Williams, Amy W., MD</creator><general>Elsevier Inc</general><general>Frontline Medical Communications Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>4U-</scope><scope>7RV</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>M2P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>S0X</scope><scope>7X8</scope></search><sort><creationdate>20161001</creationdate><title>Survival, Risk Factors, and Effect of Treatment in 101 Patients With Calciphylaxis</title><author>McCarthy, James T., MD ; el-Azhary, Rokea A., MD, PhD ; Patzelt, Michelle T., MD ; Weaver, Amy L., MS ; Albright, Robert C., DO ; Bridges, Alina D., DO ; Claus, Paul L., MD ; Davis, Mark D.P., MD ; Dillon, John J., MD ; El-Zoghby, Ziad M., MD ; Hickson, LaTonya J., MD ; Kumar, Rajiv, MD ; McBane, Robert D., MD ; McCarthy-Fruin, Kathleen A.M., BA ; McEvoy, Marian T., MD ; Pittelkow, Mark R., MD ; Wetter, David A., MD ; Williams, Amy W., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c515t-9cdef4c9abdb4ff3c6468d31e2aa08f6d25f3a1cebcd88106960809d3b3bc22b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Analysis</topic><topic>Calcification</topic><topic>Calciphylaxis - complications</topic><topic>Calciphylaxis - mortality</topic><topic>Calciphylaxis - therapy</topic><topic>Care and treatment</topic><topic>Chronic kidney failure</topic><topic>Debridement</topic><topic>Diabetes Mellitus</topic><topic>Female</topic><topic>Glomerular Filtration Rate</topic><topic>Humans</topic><topic>Hyperbaric Oxygenation</topic><topic>Hyperparathyroidism - etiology</topic><topic>Hyperparathyroidism - surgery</topic><topic>Hypertension - complications</topic><topic>Internal Medicine</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Minnesota - epidemiology</topic><topic>Neoplasms - complications</topic><topic>Obesity - complications</topic><topic>Parathyroidectomy</topic><topic>Patient outcomes</topic><topic>Renal Insufficiency, Chronic - classification</topic><topic>Renal Insufficiency, Chronic - complications</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Severity of Illness Index</topic><topic>Thiosulfates - therapeutic use</topic><topic>Tissue Plasminogen Activator - therapeutic use</topic><topic>Treatment outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>McCarthy, James T., MD</creatorcontrib><creatorcontrib>el-Azhary, Rokea A., MD, PhD</creatorcontrib><creatorcontrib>Patzelt, Michelle T., MD</creatorcontrib><creatorcontrib>Weaver, Amy L., MS</creatorcontrib><creatorcontrib>Albright, Robert C., DO</creatorcontrib><creatorcontrib>Bridges, Alina D., DO</creatorcontrib><creatorcontrib>Claus, Paul L., MD</creatorcontrib><creatorcontrib>Davis, Mark D.P., MD</creatorcontrib><creatorcontrib>Dillon, John J., MD</creatorcontrib><creatorcontrib>El-Zoghby, Ziad M., MD</creatorcontrib><creatorcontrib>Hickson, LaTonya J., MD</creatorcontrib><creatorcontrib>Kumar, Rajiv, MD</creatorcontrib><creatorcontrib>McBane, Robert D., MD</creatorcontrib><creatorcontrib>McCarthy-Fruin, Kathleen A.M., BA</creatorcontrib><creatorcontrib>McEvoy, Marian T., MD</creatorcontrib><creatorcontrib>Pittelkow, Mark R., MD</creatorcontrib><creatorcontrib>Wetter, David A., MD</creatorcontrib><creatorcontrib>Williams, Amy W., MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>University Readers</collection><collection>Nursing & Allied Health Database</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>eLibrary</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Science Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>SIRS Editorial</collection><collection>MEDLINE - Academic</collection><jtitle>Mayo Clinic proceedings</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>McCarthy, James T., MD</au><au>el-Azhary, Rokea A., MD, PhD</au><au>Patzelt, Michelle T., MD</au><au>Weaver, Amy L., MS</au><au>Albright, Robert C., DO</au><au>Bridges, Alina D., DO</au><au>Claus, Paul L., MD</au><au>Davis, Mark D.P., MD</au><au>Dillon, John J., MD</au><au>El-Zoghby, Ziad M., MD</au><au>Hickson, LaTonya J., MD</au><au>Kumar, Rajiv, MD</au><au>McBane, Robert D., MD</au><au>McCarthy-Fruin, Kathleen A.M., BA</au><au>McEvoy, Marian T., MD</au><au>Pittelkow, Mark R., MD</au><au>Wetter, David A., MD</au><au>Williams, Amy W., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Survival, Risk Factors, and Effect of Treatment in 101 Patients With Calciphylaxis</atitle><jtitle>Mayo Clinic proceedings</jtitle><addtitle>Mayo Clin Proc</addtitle><date>2016-10-01</date><risdate>2016</risdate><volume>91</volume><issue>10</issue><spage>1384</spage><epage>1394</epage><pages>1384-1394</pages><issn>0025-6196</issn><eissn>1942-5546</eissn><coden>MACPAJ</coden><abstract>Abstract Objective To report on the survival and the associations of treatments upon survival of patients with calciphylaxis seen at a single center. Patients and Methods Using the International Classification of Diseases, Ninth Revision diagnosis code of 275.49 and the keyword “calciphylaxis” in the dismissal narrative, we retrospectively identified 101 patients with calciphylaxis seen at our institution between January 1, 1999, through September 20, 2014, using a predefined, consensus-developed classification scheme. Results The average age of patients was 60 years: 81 (80.2%) were women; 68 (68.0%) were obese; 19 (18.8%) had stage 0 to 2 chronic kidney disease (CKD), 19 (18.9%) had stage 3 or 4 CKD; 63 (62.4%) had stage 5 or 5D (dialysis) CKD. Seventy-five patients died during follow-up. Six-month survival was 57%. Lack of surgical debridement was associated with insignificantly lower 6-month survival (hazard ratio [HR]=1.99; 95% CI, 0.96-4.15; P =.07) and significantly poorer survival for the entire duration of follow-up (HR=1.98; 95% CI, 1.15-3.41; P =.01), which was most pronounced in stage 5 or 5D CKD (HR=1.91; 95% CI, 1.03-3.56; P =.04). Among patients with stage 5/5D CKD, subtotal parathyroidectomy (performed only in patients with hyperparathyroidism) was associated with better 6-month (HR=0.12; 95% CI, 0.02-0.90; P =.04) and overall survival (HR= 0.37; 95% CI, 0.15-0.87; P =.02). Conclusion Calciphylaxis is associated with a high mortality rate. Significantly effective treatments included surgical debridement and subtotal parathyroidectomy in patients with stage 5/5D CKD with hyperparathyroidism. Treatments with tissue-plasminogen activator, sodium thiosulfate, and hyperbaric oxygen therapy were not associated with higher mortality.</abstract><cop>England</cop><pub>Elsevier Inc</pub><pmid>27712637</pmid><doi>10.1016/j.mayocp.2016.06.025</doi><tpages>11</tpages></addata></record> |
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| recordid | cdi_proquest_miscellaneous_1835372757 |
| source | MEDLINE; Alma/SFX Local Collection |
| subjects | Adult Aged Aged, 80 and over Analysis Calcification Calciphylaxis - complications Calciphylaxis - mortality Calciphylaxis - therapy Care and treatment Chronic kidney failure Debridement Diabetes Mellitus Female Glomerular Filtration Rate Humans Hyperbaric Oxygenation Hyperparathyroidism - etiology Hyperparathyroidism - surgery Hypertension - complications Internal Medicine Male Middle Aged Minnesota - epidemiology Neoplasms - complications Obesity - complications Parathyroidectomy Patient outcomes Renal Insufficiency, Chronic - classification Renal Insufficiency, Chronic - complications Retrospective Studies Risk Factors Severity of Illness Index Thiosulfates - therapeutic use Tissue Plasminogen Activator - therapeutic use Treatment outcome Young Adult |
| title | Survival, Risk Factors, and Effect of Treatment in 101 Patients With Calciphylaxis |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-08T03%3A53%3A03IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_proqu&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Survival,%20Risk%20Factors,%20and%20Effect%20of%20Treatment%20in%20101%20Patients%20With%20Calciphylaxis&rft.jtitle=Mayo%20Clinic%20proceedings&rft.au=McCarthy,%20James%20T.,%20MD&rft.date=2016-10-01&rft.volume=91&rft.issue=10&rft.spage=1384&rft.epage=1394&rft.pages=1384-1394&rft.issn=0025-6196&rft.eissn=1942-5546&rft.coden=MACPAJ&rft_id=info:doi/10.1016/j.mayocp.2016.06.025&rft_dat=%3Cgale_proqu%3EA470463322%3C/gale_proqu%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1826103780&rft_id=info:pmid/27712637&rft_galeid=A470463322&rft_els_id=S0025619616303676&rfr_iscdi=true |