Surgical Debridement Improves Survival in Calciphylaxis Patients

Subtotal parathyroidectomy may lower the death risk of patients with secondary hyperparathyroidism and calciphylaxis.
Subtotal parathyroidectomy may lower the death risk of patients with secondary hyperparathyroidism and calciphylaxis.

Surgical debridement and subtotal parathyroidectomy (sPTx) may improve survival of patients with calciphylaxis, a rare but often fatal condition, according to new study.

In a retrospective study of 101 patients with confirmed calciphylaxis, lack of surgical debridement nearly doubled the risk of death at 6 months and overall, although results were statistically insignificant. Subtotal parathyroidectomy was associated with a significant 78% increased odds of survival 6 months after diagnosis and 63% better odds of survival overall compared with no surgery among a subset of patients with stage 5/5D chronic kidney disease (CKD) and secondary hyperparathyroidism (SHPT). During a subtotal parathyroidectomy, surgeons remove 1 or more parathyroid glands.

“We recommend that aggressive wound debridement be used in all patients,” James T. McCarthy, MD, of Mayo Clinic in Rochester, Minnesota, and colleagues wrote in Mayo Clinic Proceedings. “In patients with stage 5/5D CKD with PTH level of more than 400 pg/mL, we would urge consideration of subtotal parathyroidectomy for rapid treatment of hyperparathyroidism.”

Since no patient received long-term cinacalcet or bisphosphonate therapy, the investigators could not assess the efficacy of these drugs.

Treatment with tissue-plasminogen activator, sodium thiosulfate, and hyperbaric oxygen therapy were not associated with mortality, but the investigators urged clinicians to consider these therapies in appropriate patients. A previous study found benefits with use of tissue-plasminogen activator, for example (JAMA Dermatol. 2013;149:63-67). The investigtors also suggested warfarin cessation. 

Of the 101 calciphylaxis patients, 18.8% had stage 0 to 2 CKD, 18.9% stage 3 or 4, and 62.4% stage 5 or 5D (dialysis). Some patients without CKD also developed calciphylaxis for unknown reasons, possibly hypercoagulation. Many patients had comorbidities, such as 26.9% with SHPT and 68% with obesity. The 75 patients who died during follow-up produced a 6-month survival rate of 57%.

Since the study lacked information on treatment durations and dosages, some analyses were not possible. 

Source

1.    1. McCarthy JT, el-Azhary RA, Patzelt MT, et al. Survival, Risk Factors, and Effect of Treatment in 101 Patients With Calciphylaxis. Mayo Clin Proc. doi: 10.1016/j.mayocp.2016.06.025.

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