PMID- 30940121
OWN - NLM
STAT- MEDLINE
DCOM- 20200508
LR  - 20200508
IS  - 1471-2369 (Electronic)
IS  - 1471-2369 (Linking)
VI  - 20
IP  - 1
DP  - 2019 Apr 2
TI  - Phenprocoumon based anticoagulation is an underestimated factor in the 
      pathogenesis of calciphylaxis.
PG  - 114
LID - 10.1186/s12882-019-1301-6 [doi]
LID - 114
AB  - BACKGROUND: Calciphylaxis is a life threatening complication in renal patients. 
      Of great importance is the identification of concomitant factors for 
      calciphylaxis. Due to the variability of clinical presentation the evaluation of 
      such factors may be obscured when calciphylaxis diagnosis is based just on 
      clinical features. We aimed to characterize associated factors only in patients 
      with calciphylaxis proven by histomorphological parameters in addition to 
      clinical presentation. METHODS: In a single center retrospective study we 
      analyzed 15 patients in an 8 year period from 2008 to 2016. Only patients with 
      clinical features and histomorphological proof of calciphylaxis were included. 
      Criteria for histological diagnosis of calciphylaxis were intimal hyperplasia, 
      micro thrombi or von Kossa stain positive media calcification. RESULTS: The mean 
      age of patients was 64.8 years. Nine patients (60%) were female; 12 (80%) were 
      obese with a Body-Mass-Index (BMI) > 30 kg/m(2); 3 (20%) had no renal disease; 12 
      (80%) had CKD 4 or 5 and 10 (66.7%) had end-stage renal disease (ESRD). One-year 
      mortality in the entire cohort was 73.3%. With respect to medication history, the 
      majority of patients (n = 13 (86.7%)) received vitamin K antagonists (VKA); 10 
      (66.7%) were treated with vitamin D; 6 (40%) had oral calcium supplementation; 5 
      (33.3%) had been treated with corticosteroids; 12 (80%) were on proton pump 
      inhibitors (PPI); 13 (86.7%) patients had a clinical proven hyperparathyroidism. 
      Ten (66.7%) patients presented with hypoalbuminemia at diagnosis. CONCLUSIONS: 
      The evaluation of biopsy proven calciphylaxis demonstrates that especially 
      treatment with vitamin K antagonists and liver dysfunction are most important 
      concomitant factors in development of calciphylaxis. As progression and 
      development of calciphylaxis are chronic rather than acute processes, early use 
      of DOACs instead of VKA might be beneficial and reduce the incidence of 
      calciphylaxis.
FAU - Russ, Philipp
AU  - Russ P
AD  - Department of Nephrology, University Hospital of Marburg, UKGM GmbH, 
      Baldingerstrasse 1, 35033, Marburg, Germany.
FAU - Russwurm, Martin
AU  - Russwurm M
AD  - Department of Nephrology, University Hospital of Marburg, UKGM GmbH, 
      Baldingerstrasse 1, 35033, Marburg, Germany.
FAU - Kortus-Goetze, Birgit
AU  - Kortus-Goetze B
AD  - Department of Nephrology, University Hospital of Marburg, UKGM GmbH, 
      Baldingerstrasse 1, 35033, Marburg, Germany.
FAU - Hoyer, Joachim
AU  - Hoyer J
AD  - Department of Nephrology, University Hospital of Marburg, UKGM GmbH, 
      Baldingerstrasse 1, 35033, Marburg, Germany. hoyer@med.uni-marburg.de.
FAU - Kamalanabhaiah, Sahana
AU  - Kamalanabhaiah S
AD  - Department of Nephrology, University Hospital of Marburg, UKGM GmbH, 
      Baldingerstrasse 1, 35033, Marburg, Germany.
LA  - eng
PT  - Journal Article
DEP - 20190402
PL  - England
TA  - BMC Nephrol
JT  - BMC nephrology
JID - 100967793
RN  - 0 (Anticoagulants)
RN  - Q08SIO485D (Phenprocoumon)
SB  - IM
MH  - Anticoagulants/therapeutic use
MH  - Biopsy/methods
MH  - *Calciphylaxis/epidemiology/etiology/pathology/prevention & control
MH  - Female
MH  - Germany/epidemiology
MH  - Humans
MH  - Incidence
MH  - *Kidney Failure, Chronic/complications/diagnosis/mortality
MH  - Liver Diseases/epidemiology
MH  - Male
MH  - Microvessels/pathology
MH  - Middle Aged
MH  - Mortality
MH  - Patient Selection
MH  - Phenprocoumon/*therapeutic use
MH  - Retrospective Studies
MH  - Risk Factors
MH  - *Thrombosis/etiology/pathology/prevention & control
MH  - *Vascular Calcification/etiology/pathology/prevention & control
PMC - PMC6444830
OTO - NOTNLM
OT  - Calciphylaxis
OT  - Inflammation
OT  - Ischemia
OT  - Phosphatemia
OT  - Vascular calcification
COIS- ETHICS APPROVAL AND CONSENT TO PARTICIPATE: The ethics committee of the 
      department of medicine of Philipps-University of Marburg granted the permission 
      in order to access patient database. The consent to participate was given in 
      written. CONSENT FOR PUBLICATION: Not applicable. COMPETING INTERESTS: The 
      authors declare that they have no competing interests. PUBLISHER'S NOTE: Springer 
      Nature remains neutral with regard to jurisdictional claims in published maps and 
      institutional affiliations.
EDAT- 2019/04/04 06:00
MHDA- 2020/05/10 06:00
PMCR- 2019/04/02
CRDT- 2019/04/04 06:00
PHST- 2018/10/11 00:00 [received]
PHST- 2019/03/18 00:00 [accepted]
PHST- 2019/04/04 06:00 [entrez]
PHST- 2019/04/04 06:00 [pubmed]
PHST- 2020/05/10 06:00 [medline]
PHST- 2019/04/02 00:00 [pmc-release]
AID - 10.1186/s12882-019-1301-6 [pii]
AID - 1301 [pii]
AID - 10.1186/s12882-019-1301-6 [doi]
PST - epublish
SO  - BMC Nephrol. 2019 Apr 2;20(1):114. doi: 10.1186/s12882-019-1301-6.