This is a RARE entity (only about 5% of ESRD patients) but has a HIGH mortality (60-80% in 1 year!)
Etiology: Abnormal deposition of calcium in the lumen of the arterial vasculature leading to compromised blood flow to the tissues and necrosis
Risk factors: Female sex, autoimmune disease, prednisone or coumadin use, elevated phosphorus levels, obesity, diabetes, and low albumin. Higher risk of development if you have a calcium x phosphorus level > 60-70.
Clinical presentation: Painful subcutaneous nodules with overlying red/brown patches and eventual central necrosis and eschars. Usually located in areas of high adipose tissue (thighs, abdomen, etc)
Treatment: Mostly supportive – have your patients eat a low phosphate diet and use non-calcium containing phosphate binders! (Remember, the calcium containing ones will cause more harm because it will still elevated your calcium x phosphate product!). Studies have shown some benefit to using sodium thiosulfate and hyperbaric oxygen but calciphylaxis cannot be cured.