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Clinical characteristics and risk factors associated with mortality in calcific uremic arteriolopathy

  • Nephrology - Original Paper
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Abstract

Background

Calcific uremic arteriolopathy (CUA) is an often-fatal condition in dialysis patients. The clinical descriptions and treatments of CUA patients have been confined mostly to case reports. We report a comprehensive characterization of CUA and its associated diagnosis, treatment patterns, and outcome.

Methods

An internet-based registry collected information about CUA in dialysis patients. Univariate analysis using Cox proportional hazards models estimated hazard ratios of the association between clinical characteristics, laboratory values, and treatments with all-cause mortality.

Results

A total of 117 CUA patients had adequate information for analysis. The majority of patients (56.7%) were diagnosed clinically, with only 32.5% biopsied. Debridement was undertaken in 42.6% of cases. Intravenous sodium thiosulfate (STS) was initiated in 54.7% of patients; most received ≥ 12.5 g of STS (98.3%) for < 3 months (79.7%). Mean parathyroid hormone (PTH) and phosphorus (P) were 459 ± 492 pg/mL and 6.3 ± 2.1 mg/dL, respectively. A total of 24 patients (21.6%, of 111 with information) died, with a median survival time of 2.9 months. In univariate analysis, higher mortality was observed in patients with cardiovascular disease (CVD; HR = 10.47; 95% CI 1.40–78.38), those taking warfarin at time of diagnosis (HR = 2.74; 95% CI 1.16–6.51), and those who had both diabetes (DM) and CVD and who were taking warfarin (HR = 13.41; 95% CI 1.66–109.29).

Conclusions

In real-world clinical practice, there is substantial variability in the diagnosis and treatment of CUA. There is usually only modest derangement of bone and mineral parameters at the time of diagnosis. Death is common. The presence of CVD and use of warfarin may influence clinical outcome after diagnosis of CUA.

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Acknowledgements

The authors thank John Mehren, University of Kansas Medical Center Information Technology Department, for assisting in the creation and maintenance of the registry.

Author information

Authors and Affiliations

  1. Arizona Kidney Disease and Hypertension Center, 18699 N. 69th Avenue, Suite 280, Glendale, Phoenix, AZ, 85308, USA

    Peter W. Santos

  2. Department of Biostatistics, University of Kansas, Medical Center, Kansas City, KS, USA

    Jianghua He

  3. Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, KS, USA

    Ahmad Tuffaha

  4. Division of Nephrology, Hennepin County Medical Center, Minneapolis, MN, USA

    James B. Wetmore

Authors
  1. Peter W. Santos
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  2. Jianghua He
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  3. Ahmad Tuffaha
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  4. James B. Wetmore
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Contributions

PWS and JBW designed the registry; PWS maintained the integrity of the registry; PWS, JH, AT, and JBW performed the data analysis; PWS and JBW wrote the manuscript; PWS and JBW had primary responsibility for the final content. All authors read and approved the final manuscript version.

Corresponding author

Correspondence to Peter W. Santos.

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Conflict of interest

JBW is on the Speakers’ Bureau for OPKO Renal. The other authors have no relevant financial or personal conflicts to declare.

Appendix

Appendix

Question domains of the KUMC CUA Registry

  • 1. Profession or qualification of the individual entering the data

  • 2. Demographic characteristics of the patient

  • 3. Medical comorbidities

  • 4. Primary cause of ESRD

  • 5. Method of diagnosis of presumed CUA

  • 6. Number and location of CUA lesion

  • 7. Whether patient was hospitalized

  • 8. Whether CUA caused sepsis

  • 9. Medications at time of diagnosis (e.g., vitamin K antagonist, vitamin D sterols, phosphate binders, and cinacalcet)

  • 10. Laboratory values at or near time of diagnosis (e.g., serum Ca, P, PTH, and Alb)

  • 11. Treatments attempted

  • 12. Whether surgical debridement was undertaken

  • 13. Approximate date of CUA diagnosis

  • 14. Approximate date of death, if applicable

  • 15. Current (and, if applicable, previous) mode of dialysis

  • 16. Adequacy of dialysis at time of diagnosis

  • 17. History of previous renal transplant, if applicable

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Santos, P.W., He, J., Tuffaha, A. et al. Clinical characteristics and risk factors associated with mortality in calcific uremic arteriolopathy. Int Urol Nephrol 49, 2247–2256 (2017). https://doi.org/10.1007/s11255-017-1721-9

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  • DOI: https://doi.org/10.1007/s11255-017-1721-9

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