Calciphylaxis
Calcific uraemic arteriolopathy in dialysis patients, the risk factors you can change (warfarin, calcium, active vitamin D, PTH), painful retiform purpura before ulcers, biopsy and its risks, sodium thiosulfate and the thin evidence, and early palliative input.
Tier 1Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Rare, painful and often fatal. It mostly affects people on dialysis, with an incidence of about 3.5 per 1,000 patient-years on haemodialysis in the largest US registry. It also occurs in earlier CKD, after transplant, and without kidney disease.
- Pain comes first. Severe, deep pain in fatty skin, then indurated plaques and retiform (net-like, stellate) purpura, then black eschar and ulcers.
- 1-year mortality is 36 to 74%, mostly from wound sepsis.
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Sources
- Huish S et al. Calciphylaxis diagnosis, management and future directions: a comprehensive update on behalf of the European Renal Association CKD-MBD Working Group. Clin Kidney J 2025;18European Renal Association (Clinical Kidney Journal), 2025
- KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD)Kidney Disease Improving Global Outcomes (KDIGO), 2017 (kdigo.org CKD-MBD page lists no newer version, checked 11 November 2026)
- Sodium thiosulfate in calciphylaxis in dialysis patients (SESLHDMG 140)AU/NZSouth Eastern Sydney Local Health District, NSW Health, 2025 (the direct PDF link returned 404 on 13 November 2026; find SESLHDMG 140 on the SESLHD policies page)
- Therapeutic Guidelines: DermatologyAU/NZTherapeutic Guidelines Limited (eTG complete), current eTG edition (topic version not verified)
- Sinha S et al. Hexasodium fytate for the treatment of calciphylaxis: a randomised, double-blind, phase 3, placebo-controlled trial with an open-label extension (CALCIPHYX). EClinicalMedicine 2024;75:102784EClinicalMedicine (The Lancet Discovery Science), 2024
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Deploy to Cloudflare on push to main