Nephrol Dial Transplant (2001) 16: 2176-2180
© 2001 European Renal Association-European Dialysis and Transplant Association
Hyperbaric oxygen in the treatment of calciphylaxis: a case series
1 Division of Nephrology, Department of Medicine, Kidney Research Centre, Ottawa Health Research Institute and 2 Department of Anesthesiology, Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
Background. Calciphylaxis, also referred to as calcific uraemic arteriolopathy, is a syndrome associated with end-stage renal disease (ESRD), and causes necrotic skin ulcers, often leading to a fatal outcome. Hyperbaric oxygen (HBO2) therapy has been used to enhance wound healing, but its role in the treatment of calciphylaxis is unclear.
Methods. We undertook a retrospective study of patients on renal replacement therapy with biopsy-proven calciphylaxis who were treated with HBO2 between March 1997 and February 2000.
Results. Five patients were treated with HBO2: three patients were on continuous ambulatory peritoneal dialysis (CAPD) and two were on chronic haemodialysis therapy. None of the patients had uncontrolled hyperparathyroidism and none underwent parathyroidectomy. The patients each received 25–35 treatments of HBO2 at 2.5 atmospheres for 90 min per treatment. Two of these patients had complete resolution of extensive necrotic skin ulcers, with no adverse effects of HBO2 therapy. Both had improvement in wound area transcutaneous oxygen pressure (PtcO2) with administration of 100% oxygen when measurements were taken at normobaric and hyperbaric pressures. In the other three patients receiving HBO2, the skin lesions did not resolve. PtcO2 was measured in two of these patients, neither of whom showed improvement with 100% oxygen administered at normobaric pressure.
Conclusions. The data support a role for HBO2 in the treatment of some patients with calciphylaxis, particularly as in the absence of uncontrolled secondary hyperparathyroidism there are few therapeutic options.
Keywords: calciphylaxis; dialysis; hyperbaric oxygen; renal failure
Correspondence and offprint requests to: Kevin D. Burns MD, FRCPC, Head, Division of Nephrology, Department of Medicine, Ottawa Hospital and University of Ottawa, 501 Smyth Road, LM-18, Ottawa, Ontario, Canada K1H 8L6. Email: kburns{at}ottawahospital.on.ca
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