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:
- Warfarin discontinued, replaced with apixaban
- Surgical debridement and hyperbaric oxygen therapy for wound healing
- Avoid use of morphine in patients with renal failure; replace with fentanyl and methadone (no active metabolites that accumulate in patients with renal failure)
- Sodium thiosulfate treatment for wound healing may also have benefits for pain control.
|
VI |
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:
- Referral to palliative medicine, wound care specialists
- Continuous subcutaneous infusion of alfentanil for pain control, dosage adjusted according to pain relief and neurotoxicity
- Morphine, oxycodone, tramadol, and codeine to be avoided because of neurotoxicity in renal failure patients
- Gabapentin (100 mg) for neuropathic pain
- Stepwise approach for procedural analgesia beginning with short-acting fentanyl, progressing to subcutaneous fentanyl, sedation with midazolam, and general anesthesia with propofol and fentanyl
|
VII |
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 |