Calciphylaxis Episodes in the Australia and New Zealand Dialysis and Transplant Registry.

Toussaint, Nigel D; Davies, Christopher E; Bongetti, Elisa; Ruderman, Irene; Elder, Grahame J; Hawley, Carmel M; Krishnasamy, Rathika; Roberts, Matthew A; Jardine, Meg J; De Zoysa, Janak R; McDonald, Stephen P.

Toussaint ND; Department of Nephrology, The Royal Melbourne Hospital, Parkville, Australia.
Davies CE; Department of Medicine (RMH), University of Melbourne, Parkville, Australia.
Bongetti E; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia.
Ruderman I; Australia and New Zealand Dialysis and Transplant Registry, South Australian Health and Medical Research Institute, Adelaide, Australia.
Elder GJ; Department of Nephrology, Monash Medical Centre, Clayton, Australia.
Hawley CM; Department of Nephrology, The Royal Melbourne Hospital, Parkville, Australia.
Krishnasamy R; Department of Medicine (RMH), University of Melbourne, Parkville, Australia.
Roberts MA; School of Medicine, University of Notre Dame, Sydney, Australia.
Jardine MJ; Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
De Zoysa JR; Skeletal Biology Program, Garvan Institute of Medical Research, Darlinghurst, Australia.
McDonald SP; Department of Nephrology, Westmead Hospital, Sydney, Australia.

Kidney Int Rep ; 9(4): 951-959, 2024 Apr.

Article en En | MEDLINE | ID: mdl-38765561

ABSTRACT

Introduction:

Calciphylaxis is a rare disorder associated with significant morbidity and mortality. Data registries are an invaluable source of information for rare diseases. We reviewed cases of calciphylaxis recorded in the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) and evaluated associations and outcomes of this condition.

Data was obtained on all cases of calciphylaxis reported between 2019 and 2022 in Australian and New Zealand patients on kidney replacement therapy (KRT). This cohort was compared to all patients in the registry who received KRT from 2019 to 2022 without an episode of calciphylaxis. Cox proportional hazards regression including a time-varying covariate for calciphylaxis episode was conducted for mortality with models restricted to patients on dialysis only.

From 2019 to 2022, 333 patients had calciphylaxis episodes reported. Overall incidence rate for patients on dialysis was 4.5 (4.1-5.1) episodes per 1000 patient-years on dialysis. Median age was 63 (interquartile range [IQR] 55-73) years, 54% were female, 66% had diabetes, 59% were obese (body mass index [BMI] ≥ 30 kg/m2) and 77% were receiving hemodialysis (HD) treatment. Compared to patients without calciphylaxis (n = 46,526), patients with calciphylaxis were more likely to be older, female, and have diabetes, greater BMI, coronary artery, and peripheral vascular disease. The median time to calciphylaxis was 3.2 (IQR 0.9-6.7) years after KRT commencement. Half of the patients with calciphylaxis died by 12 months from diagnosis. Adjusted hazard ratio (HR) of mortality for patients on dialysis with calciphylaxis <1 year and 1 to 4 years after an episode was 5.8 (4.9-6.9) and 1.5 (1.0-2.1), respectively compared to patients on dialysis without calciphylaxis.