Calcific Uremic Arteriolopathy in Peritoneal Dialysis Populations

Table 2

CUA cases within our local PD population.

Patient characteristics	PD duration	Clinical presentation	CCa^2+ (mmol/L)	PO4^− (mmol/L)	PTH (ng/L)	Treatment	Response to treatment
79 yo female ESRD (? cause) HTN, IHD, PVD, dyslipidemia, depression	9 years CAPD	Painful bilateral foot ulceration	2.64	2.16	598	D/C calcium carbonate and calcitriol Started cinacalcet and aluminium OHSTS (IV) 3 monthsIntensive PD—change to HD	With STS and change to HD lesions resolvedDied 7/12 after resolution of lesions. Withdrawal of HD for functional decline
67 yo male ESKD (FSGS) IHD, HTN, dyslipidemia, OSA, BPH, GORD	7 months CAPD	Painful red violaceous ulceration right calf: Multiple indurated lesions on thighs and bilateral calf	2.42	2.61	1386	Started cinacalcet. Parathyroidectomy and STS (IV) 6 months commenced at same time. Caltrate and calcitriol not stopped due to hungry bone	Complete resolution of lesions including ulceration. Died 18 months later with ischemic CCF not for intervention
75 yo male ESKD (DM/ obstructive) DM, IHD, dyslipidemia, CVA, GORD, HTN, gout	7 months CAPD	Ulcerations right anterior lower leg, initially presumed DM ulcers	2.73	1.73	132	D/C calcium carbonate. Started sevelamer, cinacalcet, aluminium OHHBO + pamidronate + Intensive PD STS (IV) 5 weeksPD changed to HD while on STS	No response to change in phosphate binders. Pain relief gained while on STS but no wound healing. Ulcers began to heal off STS after HD initiated. Died secondary to sepsis
74 yo male ESKD (ADPKD) PVD, HTN, gout, ex-smoker	3 years CAPD	Painful ulceration of left shin, superimposed infection	2.45	2.28	38	Prior Parathyroidectomy. STS (IP) 12 weeks + HBO for 5 days. PD changed to HD after 2nd PD peritonitis	Complete response was documented. STS complicated by 2 episodes PD peritonitis and was D/C
28 yo female ESKD (SLE) AIHA, Epilepsy, HTN	27 months CAPD	4 painful ulcerating lesions left lower leg medial and posterior	2.42	1.90	8.54	Started sevelamer. STS (IP) 3 months −25 g was reduced to 12.5 g for nausea. HBO 30 treatments	Complete response, with durability to 2 years. Remaining on PD

PD peritoneal dialysis, CCa²⁺ corrected calcium, PO₄⁻ phosphate, PTH parathyroid hormone, ESRD (aetiology), HD haemodialysis, HTN hypertension, IHD ischemic heart disease, PVD peripheral vascular disease, CAPD continuous abdominal PD, D/C discontinue, STS sodium thiosulphate, IV intravenous, IP intraperitoneal, OSA obstructive sleep apnoea, AIHA autoimmune hemolytic anemia, DM diabetes mellitus, CVA cerebrovascular accident, and HBO hyperbaric oxygen therapy.