Managing Non-uremic Calcific Arteriolopathy: An Interview With the Author

Dr. Laura Swoboda shares background and additional details from her case series, Clinical Management of Nonuremic Calcific Arteriolopathy: A Report of Three Cases. Read the full article here.
 

Transcript:

Hi, I am Dr. Laura Swoboda, family nurse practitioner and professor of translational science with Froedtert and the Medical College of Wisconsin. This manuscript discusses calcific arteriolopathy that involves the deposition of insoluble calcium salts in the vasculature in addition to the soft tissues. Those deposits cause ischemia. They can also cause thrombosis, which leads to tissue destruction and ultimately wounds. Calcific arteriolopathy is usually associated with end-stage renal disease, we see it in patients on dialysis. But sometimes it occurs outside of end stage renal disease, and then it's known as non-uremic calcific arteriolopathy. So this manuscript discusses this rare subsection of the rare disease of calciphylaxis. And in this patient cohort, we had very good outcomes, successful outcomes, healing these patients. We know that the mortality rate of calcific arteriolopathy is about 50%, so very high, and about 50% of that mortality is associated with sepsis. So in managing these wound patients, we focused on pain management.

So we were able to provide adequate wound hygiene. Really clean the wound, use antimicrobial dressings, and then focus on debridement and managing infection. So in each case, the patients did develop infections. And we had to manage those early and aggressively to prevent, again, that comorbidities. The mortality associated with calcific arteriolopathy. We had very good outcomes. The mean time to heal was about 20 weeks for this patient cohort. And in addition to this topical management, all patients were managed with sodium thiosulfate infusions. So this manuscript describes how many infusions they received, what co-medications we gave them with the sodium thiosulfate therapy, and also the use of non-contact low frequency ultrasound, which we used in one of the cases in this cohort of patients.

So what led me to create a report on non-uremic calcific arteriolopathy is that it is a rare disease. So calciphylaxis, or calcific arteriolopathy, is a pretty unusual disease process in and of itself, but that's usually associated with end-stage renal disease in our dialysis patients. These cases occurred outside of end-stage renal disease and hemodialysis. So it was a rare subset of a rare disease. And in addition to that, we had very good outcomes. So not only did we have no mortality, all of the patients survived, they healed in a pretty reasonable timeframe, a mean of 20 weeks. And we were able to control their infection, their pain with really good wound hygiene. All described in the manuscript. So I wanted to report on these positive outcomes so that they can be recreated. And also report on the early symptoms that these patients were exhibiting to just have everybody realize, if someone presents on day one with purpura and pain out of proportion to the wound, that you can just go ahead and biopsy that right away. And start thinking, "Is this possibly calcific arteriolopathy?"

So I think the surprising results are that everybody lived and went on to have good, positive outcomes. They didn't have any long-term impact to their health as a result of the wounds. You can look at their liver function, kidney function long-term, that type of a thing. But in terms of wound management, all very successful outcomes. Again, no mortality. So in a disease process where we know the average is about 50% mortality, sepsis causing 50% of that mortality, to have everybody live, and to have the wounds heal in a pretty good amount of time was surprising and positive. So I think going back, practicing evidence-based practice, trusting the research led to really good outcomes for these patients.

Yeah, so one of the things that one of the reviewers had talked about was, what other research is out there on non-uremic calcific arteriolopathy. And what was really out there now was pharmaceutical management. So looking at sodium thiosulfate, or what kind of pharmacological interventions you could do, but not a lot about the clinical intervention of it. How often patients were coming in. What were we doing to the wounds? What kind of complications did we see? So I really described exactly what we did in terms of clinical management so that for future clinical trials, we know that this can be an effective intervention. And if this was used as the baseline, and then any new intervention was applied against that, that's certainly a possibility for the future.

I just encourage everyone to participate in the research and evidence process, and read as much as you can. And that's what led me and some of these patients. I think they had such good outcomes because they had early diagnosis. So just, I applaud everybody for going out there, reading as much as they can, to be able to ultimately impact their outcomes.