Case Series: Calciphylaxis: Do Calcimimetics Have a Role in Management?

Introduction: Calciphylaxis is a rare but serious systemic disorder characterized by small vessel calcification leading to tissue ischemia. Abnormalities in mineral metabolism that are often associated with uremia are important predisposing factors. The optimal therapy for calciphylaxis is prevention through rigorous control of phosphate and calcium balance. We here present two cases of calciphylaxis that responded to an intensive treatment protocol based on cinacalcet. Case 1: The first patient was a 60-year old lady who was on regular hemodialysis for two years. She presented with four months history of painful, necrotic, non-healing ulcers on her right leg despite intact peripheral pluses. Her calcium level was 11.6 mg/dl, phosphate 6.6 mg/dl and parathyroid hormone (PTH) 1450 pg/ml. The diagnosis of calciphylaxis was confirmed by ulcer punch biopsy. The patient was treated with cinacalcet 90 mg daily, increasing the dose of non-calcium based phosphate binders, low-calcium dialysate, and withdrawal of alfacalcidol. At the end of six months of this therapy, the ulcers almost healed and renal bone profile normalized. Case 2: The second patient was a 58-year old gentleman with advanced chronic allograft nephropathy. He presented with painful, non healing ulcers on his calf. His calcium level was 12.4 mg/dl, phosphate 5.9 mg/dl and PTH 1009 pg/ml and he had recently stopped using alphacalcidol. He was treated with cinacalcet 90 mg daily and increasing the dose of non-calcium based phosphate binders. Within three months, his renal bone profile was within target levels and his ulcers had significantly improved. Conclusion: Calcimimetics have a potential role in the treatment of calciphylaxis, as demonstrated by these two cases.