What is Calciphylaxis?

Risk Factors

Data concerning the epidemiology of calciphylaxis is limited. The two most comprehensive publications are case-control studies comprising 19 and 36 patients. Summarizing the results, female gender, diabetes mellitus, peritoneal dialysis, obesity, hypoalbuminaemia in the context of malnutrition and chronic inflammation, hyperphosphataemia, elevated calcium x phosphorous product and combined use of active vitamin D analogues with high doses of calcium-containing phosphate binders appear to be the major risk factors.

Calciphylaxis has been reported in the context of severe hyperparathyroidism, with dramatic improvement following “emergency” parathyroidectomy; however, some reports have described de novo calciphylaxis in patients who were previously parathyroidectomized, and in patients with adynamic bone disease (ABD). In both situations bone turnover is deranged and unable to serve as a ‘calcium buffer’, which favours extraosseous soft-tissue calcification.

Finally, in a number of case reports there has been an association between use of vitamin K antagonists (such as warfarin) and the development of calciphylaxis. The potential pathophysiological relevance of this observation will be discussed below.