Key result
Intravenous sodium thiosulfate provides limited clinical relief and fails to prevent death in severe calciphylaxis.
Case Report (n=1)
No
This case report and literature review highlights the critical anticoagulation dilemma in end-stage kidney disease patients with mechanical heart valves who develop warfarin-associated calciphylaxis, underscoring the lack of safe alternative anticoagulants and the importance of early diagnosis.
Anticoagulation remains unresolved in end-stage kidney disease with mechanical valves and calciphylaxis; leaves open safe alternatives to warfarin.
Calciphylaxis is a rare and life-threatening condition in patients with end-stage kidney disease (ESKD). In this case report, we reported a 72-year-old female who had undergone aortic and mitral mechanical valve replacement 22 years ago due to rheumatic aortic and mitral stenosis. Following the valve replacement, she initiated warfarin treatment. Five years ago, she received a diagnosis of uremia and has since been undergoing regular hemodialysis. Ten months prior to her current admission, she experienced excruciating pain and was diagnosed with calciphylaxis. Additionally, an electrocardiogram revealed atrial fibrillation, while echocardiography indicated that the aortic and mitral mechanical valves were appropriately positioned, with normal perivalvular surroundings and good valve leaflet activity. No noticeable thrombosis was observed in the left atrium or left atrial appendage. Color Doppler imaging showed moderate stenosis in the lower extremity arteries, with no venous thromboembolism present. Extensive eggshell-like calcification within the arterial media was detected. The patient was managed with regular hemodialysis, symptomatic treatments (including anticoagulation and analgesia), and sodium thiosulfate. Unfortunately, symptomatic management provided limited relief, and during the one-month follow-up period, the patient passed away due to septic shock. Currently, there is insufficient conclusive evidence regarding alternative influential anticoagulants or appropriate prosthetic valve selection. For individuals with ESKD receiving maintenance hemodialysis, early identification, diagnosis, and treatment of calciphylaxis are of paramount importance.
No takes yet. Share an insight, caveat, or question.
Liang et al. (2023) conducted a case report in Calciphylaxis and end-stage kidney disease with prior aortic and mitral mechanical valve replacement (n=1). Sodium thiosulfate, hemodialysis, and warfarin discontinuation was evaluated on Clinical relief of calciphylaxis and survival at 1-month follow-up. Symptomatic management and intravenous sodium thiosulfate up to 8 g during hemodialysis provided limited relief in a 72-year-old female with calciphylaxis and mechanical cardiac valves, resulting in death from septic shock at 1-month follow-up.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: