When calcium leaves its mark: a case of calciphylaxis in peritoneal dialysis. A multidisciplinary approach to the treatment of calciphylaxis
DOI:
https://doi.org/10.32818/reccmi.a11n1a2Keywords:
calciphylaxis, peritoneal dialysis, chronic kidney disease-mineral and bone disorder (CKD-MBD), skin ulcerAbstract
An 80-year-old woman with stage 5 chronic kidney disease secondary to autosomal dominant polycystic kidney disease, and on automated peritoneal dialysis, developed cutaneous calciphylaxis, an uncommon complication with high morbidity and mortality in patients on renal replacement therapy. She was admitted with pain and cellulitis in her right leg, which progressed to a painful ulcer. Calciphylaxis was confirmed by skin biopsy. A combination of renal replacement therapy was chosen, maintaining peritoneal dialysis and temporarily intensifying hemodialysis to optimize metabolic control, along with the administration of intravenous sodium thiosulfate. The multidisciplinary approach, involving Internal Medicine, Nephrology, and Dermatology, was crucial in controlling calcium-phosphorus metabolism, managing pain, preventing infections, and restoring the skin lesions. Clinical improvement following intensified dialysis and sodium thiosulfate therapy allowed for a gradual reduction in hemodialysis intensity, while maintaining peritoneal dialysis as the primary technique. This case highlights the importance of individualized and multidisciplinary management of calciphylaxis and suggests that, in selected patients, the temporary combination of renal replacement therapy techniques is effective in optimizing metabolic control and preserving quality of life.
The patient was admitted with pain and cellulitis in her right leg, which progressed to a painful ulcer. After confirming calciphylaxis through biopsy, treatment included intensified hemodialysis and intravenous sodium thiosulfate administration. Despite initial complications such as nausea and vomiting, premedication adjustments allowed better treatment tolerance.
A multidisciplinary approach was crucial, improving calcium-phosphorus metabolism control and the progression of skin lesions. Sodium thiosulfate therapy proved effective, reducing the need for hemodialysis and stabilizing the patient.
In summary, this case highlights the importance of sodium thiosulfate treatment and interdisciplinary collaboration in managing calciphylaxis complications, significantly improving the patient's quality of life.
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Copyright (c) 2026 Luis Jiménez-Jurado, Álvaro Nava-Rebollo, Verónica Fidalgo-González , Luis Arribas-Pérez
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