Vitamin K antagonists predispose to calciphylaxis in patients with end-stage renal disease.

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Galloway, Peter AG 
El-Damanawi, Ragada 
Bardsley, Victoria 
Pritchard, Nicholas R 
Fry, Andrew C 

BACKGROUND/AIMS: Calciphylaxis is associated with a poor prognosis in dialysis patients, and its pathogenesis remains incompletely understood. Although the use of vitamin K antagonists (VKA) has been implicated, previous reports are conflicting. We aimed to determine if vitamin K antagonists conferred an increased risk of calciphylaxis in patients on dialysis. METHODS: We performed a single-centre, retrospective cohort study of 2,234 patients receiving dialysis, and compared the characteristics of those with and without calciphylaxis. RESULTS: We identified 5 cases of calciphylaxis (all female) between January 2009 and December 2013. Overall, 142 patients (6.4%) were treated with VKA during the study period. Calciphylaxis was more common in the VKA group (4 of 142 patients, OR = 61, 95% CI 6.7-546, p = 0.0001). VKA was withdrawn in all cases and treatment instituted with sodium thiosulphate, cinacalcet and supportive measures. All patients recovered, although there was one sudden cerebrovascular death during follow-up. CONCLUSION: Treatment with VKA predisposes to the development of calciphylaxis.

Adult, Aged, Amputation Stumps, Anticoagulants, Arterioles, Calciphylaxis, Cohort Studies, Diabetes Mellitus, Type 2, Female, Humans, Kidney Failure, Chronic, Kidney Transplantation, Male, Middle Aged, Renal Replacement Therapy, Retrospective Studies, Venous Thrombosis, Vitamin K
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S. Karger AG
TFH is funded by the Cambridge BRC and NIHR.