Ten tips on how to deal with calciphylaxis patients

Abstract

Calciphylaxis is a devastating disease characterized by painful ischemic necrotic skin lesions, primarily affecting patients with end-stage kidney disease. Its incidence has significantly increased over the past decade. Despite substantial morbidity and mortality, the pathogenesis of calciphylaxis remains poorly understood, and currently there are currently no approved treatments available. Diagnosis largely relies on clinical suspicion; skin biopsy may be useful but is not essential, particularly when biopsy risks outweigh benefits. Effective management requires a multidisciplinary approach. Current therapeutic strategies include controlling metabolic bone disease, substituting vitamin K antagonists with alternative anticoagulants, discontinuing calcium and vitamin D supplements, optimizing dialysis protocols, and considering sodium thiosulfate. Promising novel therapies are now emerging. These 10 tips aim to help clinicians avoid common pitfalls and deliver optimal care to patients with calciphylaxis.