First author, year Study description Author recommendations/conclusions Level of evidence
Brandenburg, 2019[@137829] Open-label single-arm trial involving 14 patients with calciphylaxis who received intravenous SNF472 3 times per week for 12 weeks during hemodialysis sessions The treatment was well tolerated and wound healing, pain control, and quality of life improved. IV
Chang, 2019[@137796] Narrative review describing calciphylaxis characteristics, diagnosis, and management strategies Recommendations relevant to perioperative care:
  1. Warfarin discontinued, replaced with apixaban
  2. Surgical debridement and hyperbaric oxygen therapy for wound healing
  3. Avoid use of morphine in patients with renal failure; replace with fentanyl and methadone (no active metabolites that accumulate in patients with renal failure)
  4. Sodium thiosulfate treatment for wound healing may also have benefits for pain control.
Chinnadurai, 2020[@137831] Survey of 106 UK clinicians specializing in palliative and renal medicine that evaluated trends in pain management of calciphylaxis and gave clinical practice recommendations based on the results Authors recommended the following:
  1. Referral to palliative medicine, wound care specialists
  2. Continuous subcutaneous infusion of alfentanil for pain control, dosage adjusted according to pain relief and neurotoxicity
  3. Morphine, oxycodone, tramadol, and codeine to be avoided because of neurotoxicity in renal failure patients
  4. Gabapentin (100 mg) for neuropathic pain
  5. Stepwise approach for procedural analgesia beginning with short-acting fentanyl, progressing to subcutaneous fentanyl, sedation with midazolam, and general anesthesia with propofol and fentanyl
Darres, 2019[@137827] Retrospective analysis of 71 patients with calciphylaxis receiving sodium thiosulfate therapy who were also treated with topical cerium nitrate-silver sulfadiazine Topical cerium nitrate-silver sulfadiazine was shown to be potentially protective because of vascular decalcification, reactive oxygen species chelation, and infection prevention. The authors recommended a prospective comparative trial to confirm results. V
Garza-Mayers, 2018[@137824] Retrospective analysis of 20 patients with ESRD and calciphylaxis who were treated with apixaban for DVT or AF No adverse effects were reported. The authors suggested apixaban as a safe and effective alternative to warfarin in this patient population. V
Gould, 2021[@137837] Development of a modified version of the Bates-Jensen Wound Assessment Tool for evaluation of calcific uremic arteriolopathy (calciphylaxis) wounds specifically BWAT-CUA includes 8 items for evaluation of calciphylaxis wounds: 1) necrotic tissue type, 2) necrotic tissue amount, 3) exudate type, 4) exudate amount, 5) skin color surrounding wound, 6) peripheral tissue edema, 7) peripheral tissue induration, and 8) granulation tissue. A standardized wound assessment scale may be used for more accurate comparisons between patients in both clinical practice and in clinical research studies. VI
Maida, 2020[@137825] Two older women (85 and 69) diagnosed with nonuremic calciphylaxis presenting as lower-leg ulcers were treated with topical cannabis-based medicines Topical cannabis-based medicines were well tolerated, provided good pain control, and promoted complete wound closure. VI
Nigwekar, 2018[@137801] Matched case-control study of 62 patients that reported ORs of variables previously identified as being associated with calciphylaxis A positive association was found between calciphylaxis and hypercalcemia, hypoalbuminemia, calcitriol use, and warfarin use. The authors also tentatively identified a negative association between calciphylaxis and statin use. IV
Olaniran, 2019[@137814] Retrospective analysis of data of 24 inpatients diagnosed with calciphylaxis who died as of April 30, 2018, designed to evaluate use of palliative care consultations and end-of-life care measures Palliative care teams were consulted for only half of the patients identified, and many received intensive life-prolonging measures during a terminal admission, suggesting the need for better integration of palliative care services—especially considering the high mortality and morbidity associated with calciphylaxis. VI