Calcific Uremic Arteriolopathy in Peritoneal Dialysis Populations

Table 1

CUA cases in PD population described within the literature.

Patient numbers, patient characteristics	PD duration	Clinical presentation	CCa^2+ (mmol/L)	PO^−4 (mmol/L)	PTH (ng/L)	Treatment	Outcome	Reference
𝑛=54 most female diabetics	> 2 months	73% subcutaneous plaques 95% lower legs (95% bilateral) 5% abdomina l wall	n/a	n/a	n/a	Parathyroidectomy (𝑛=6)	5 improve
								[11]
						Change to HD (𝑛=13)	11 improve
						Steroid therapy (𝑛=19)	3 die within 3 month8 improve 8 no change
𝑛=169 female HTN, IHD, renal calculi, osteoarthritis, graves thyroid disease, osteoporosis	3 months	Unilateral right calf violaceous lesion 1.5 inch, progressing to bilateral indurated lesions calf and thighs	2.22	2.10	109	D/C caltrate, calcitriol start sevelamer prednisolone STS (IV)	Resistant to all but STS, with improved pain in 2 weeks, and reduced lesion size in 8 weeks	[12]
𝑛=126 female 2 failed transplant not on calcium salts	4 years	Violaceous lesions progressing in 6 weeks to ulcerations of left proximal arm and bilateral thigh	2.4	1.77	89	Prior parathyroidectomy, initially STS (IV) 2 months STS (IP) 4 months	STS(IV) response but D/C due to N&V. STS(IP) no response and died from sepsis	[13]
𝑛=153 female Moroccan obese, IDDM, IHD, CVA	3 years	Redness right breast progressed to ulcerate Further progressed to bilateral breast and fingertip ulceration. Further progression to thigh	2.7	2.0	1376	Parathyroidectomy mastectomy STS—although very late	Poor response to all. Poor wound healing. Died from sepsis	[14]
𝑛=117 male Afro-American Wegener’s granulomatosis (receiving cyclophosphamide and prednisolone) previous warfarin (right atrial thrombus)	3 years	Erythema and swelling bilateral metatarsals, progressed to necrotic feet and fingers, with scintigraphy evidence of widespread disease	2.42	2.68	321	D/C caltrate Sevelamer preexisting Aluminium commenced STS (IV) 3 months HBO Change to HD	Pain relief with STS but lesions progress. HBO did not halt Proceed to bilateral BKA. Change to HD 5x/week and disease healed	[15]

PD: peritoneal dialysis, CCa²⁺: corrected calcium, PO₄⁻: phosphate, PTH: parathyroid hormone, 𝑛: number, HD: hemodialysis, HTN: hypertension, IHD: ischemic heart disease, D/C: discontinue, STS: sodium thiosulphate, IV: intravenous, IP: intraperitoneal, N&V:, nausea and vomiting, IDDM: insulin-dependent diabetes mellitus, CVA: cerebrovascular accident, HBO: hyperbaric oxygen therapy, and BKA: below knee amputation.