Hypercoagulable conditions, including the presence of lupus anticoagulant, protein C deficiency, and combined thrombophilia, are significantly associated with the development of calciphylaxis in patients with chronic kidney disease (CKD), according to the results of a recent retrospective case-control study conducted at 2 large urban academic hospitals in Boston, Massachusetts and published in JAMA Dermatology.
The investigators sought to identify hypercoagulable states that are risk factors for calciphylaxis while controlling for CKD. The hypercoagulability status of patients with calciphylaxis and renal disease was compared with that of a matched control population.
Patients with hypercoagulable conditions were identified via a retrospective review of medical records reporting laboratory values. a total of 38 patients with a dermatologic diagnosis of calciphylaxis between 2006 and 2014 and concomitant CKD were compared with 104 controls (3 controls for each of the 38 case patients) with CKD. All control participants were matched with case patients with respect to age, gender, and race.
Patients with calciphylaxis had higher rates of coronary artery disease (84% vs 53%;
P <.001), type 2 diabetes (66% vs 38%; P =.04), and hyperparathyroidism (71% vs 31%; P <.001) compared with controls. Although all cases and controls had CKD, patients with calciphylaxis experienced more severe renal disease, as they were more likely than controls to have stage 5 CKD (74% vs 50%, respectively; P =.02).
Patients with calciphylaxis were significantly more likely than controls to have lupus anticoagulant (48% vs 5%, respectively; P =.001), protein C deficiency (50% vs 8%, respectively; P =.02), and combined thrombophilia (62% vs 31%, respectively; P =.02).
In a subanalysis of patients with stage 5 CKD, only the presence of lupus anticoagulant (52% vs 0%; P =.01) and combined thrombophilia (63% vs 8%; P =.004) remained significantly associated with calciphylaxis. Patients with calciphylaxis were also significantly more likely than controls to have been exposed to warfarin (50% vs 9%, respectively; P <.001).
The investigators concluded that clinicians should be aware of the association between certain hypercoagulable conditions and calciphylaxis in patients with renal disease. Increased screening and appropriate anticoagulation treatment in this population are recommended in order to reduce the risk for calciphylaxis development.
Dobry AS, Ko LN, St John J, Sloan JM, Nigwekar S, Kroshinsky D. Association between hypercoagulable conditions and calciphylaxis in patients with renal disease: a
case-control study [published online December 13, 2017]. JAMA Dermatol. doi:10.1001/jamadermatol.2017.4920