October - December 2008, Volume 4, Issue 4

Kacso I, Rusu A, Racasan S, Patiu IM, Orasan R, Rogojan A, Georgescu C, Airizer M, Moldovan D, Gherman-Caprioara M

Calcific uremic arteriolopathy related to hyperparathyroidism secondary to chronic renal failure. A case-control study

Acta Endo (Buc) 2008, 4 (4): 391-400
doi: 10.4183/aeb.2008.391

We studied the incidence, risk factors, presentation, treatment and prognosis of calcific uremic arteriolopathy (CUA) in 140 of our hemodialysis patients. Methods. Patients with CUA in the past 3 years have been compared to controls in a cross-sectional survey of 140 hemodialysis patients. Results. Prevalence of CUA was 6/140 (4.28%); common presentation was ulcerated acral necrosis. Age, sex ratio, BMI, prevalence of diabetes were similar in case (n=6) and control (n=134) patients. CUA patients had higher serum calcium (9.58?1.25 mg/dL vs. 8.50?1.03 mg/dL, p=0.01), calcium-phosphate product (71.06?19.67 mg2/dL2 vs. 58.73?17.20 mg2/dL2, p=0.01) and parathormone levels (1854?1407 pg/mL vs. 654?776 pg/mL, p=0.0002). Differences in ingestion of calcium, active vitamin D and non-calcium containing phosphate binders in the year prior to the assessment were not significant. CUA patients had higher CRP values in the 6 preceding months than non CUA patients (6.61?9.68 mg/dL vs. 1.97?4.20 mg/dL, p=0.01); logistic regression disclosed CRP as the only predictive factor for CUA (p=0.03). 4 (66%) of the CUA patients died due to sepsis, as compared to 3(2.23%) of the control group (p=0.001). 2 of 3 parathyroidectomised patients survived. In conclusion, this is, to our knowledge, the first series of CUA reported from Eastern Europe. In our center acral, ulcerated forms of CUA in patients with severe hyperparathyroidism are predominant.

Keywords: Calcific uremic arteriolopathy, calciphylaxis, hyperparathyroidism, hemodialysis, inflammation

Correspondence: Mirela Gherman Caprioara, MD, “Mihai Manasia” Nephrology Clinic, 3-5 Clinics str., 400006 Cluj-Napoca, Romania, E-mail: mmgherman@yahoo.com