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- Title
The Effectiveness of Topical Cerium Nitrate-Silver Sulfadiazine Application on Overall Outcome in Patients with Calciphylaxis.
- Authors
Darres, Amandine; Delaval, Ronan; Fournier, Alain; Tournier, Emilie; Cointault, Olivier; Moussion, Francoise; Chauveau, Dominique; Seigneuric, Bruno; Lumbroso, Catherine; Kamar, Nassim; Ribes, David; Leou, Sylvie; Huart, Antoine; Testevuide, Pascale; Faguer, Stanislas
- Abstract
<bold>Background: </bold>Calciphylaxis (CPX) is a rare and life-threatening disease characterized by vascular calcification and development of painful and necrotizing skin lesions with a challenging management. Mechanisms of CPX are complex and include an imbalance between vascular calcification promoters and inhibitors, and frequently vitamin K deficiency.<bold>Objectives: </bold>To describe the various presentations and identify predictive factors of death in patients with CPX.<bold>Methods: </bold>In this multicenter retrospective study, we included 71 CPX patients followed in South-West France (n = 26) and in French Polynesia (n = 45), and who all received sodium thiosulfate (25 g thrice weekly for a median of 61 days).<bold>Results: </bold>Characteristics at presentation significantly differed between metropolitan and Polynesian French patients. Polynesians were less frequently on regular dialysis at the onset of CPX, had a higher incidence of diabetes mellitus and obesity, more disturbances of calcium-phosphorus metabolism, and received vitamin K antagonists less frequently than patients from South-West France. Despite intensive management, the 1-year mortality rate was 66% and median time to death was 200 days (IQR, 40; 514). The number of body areas involved (i.e., three: OR 2.70 [1.09; 6.65], p = 0.031; four: OR 8.79 [1.54; 50.29], p = 0.015) was the only predictive factor for death, whereas application of topical cerium nitrate-silver sulfadiazine was protective (OR 0.44 [0.20; 0.99], p = 0.046). Surgical debridement, hyperbaric oxygenation therapy, and geographical origin were not associated with overall outcomes.<bold>Conclusions: </bold>Cerium nitrate may lead to vascular decalcification and chelation of reactive oxygen species, and prevent infection. Cerium nitrate-silver sulfadiazine was associated with better outcomes and should be tested in a prospective comparative trial in CPX patients.
- Subjects
FRANCE; FRENCH Polynesia; POLYNESIA; CERIUM; CALCIPHYLAXIS; VITAMIN K; HYPERBARIC oxygenation; SULFADIAZINE; CERIUM oxides; TREATMENT of chronic kidney failure; CHRONIC kidney failure complications; SKIN diseases; SULFATES; SURVIVAL; RESEARCH; BACTERICIDES; COMBINATION drug therapy; RESEARCH methodology; POLYNESIANS; SILVER sulfadiazine; CHELATING agents; TRANSDERMAL medication; RETROSPECTIVE studies; EVALUATION research; CHEMICAL elements; DRUG administration; TREATMENT effectiveness; COMPARATIVE studies; VASCULAR diseases; HEMODIALYSIS
- Publication
Dermatology (10188665), 2019, Vol 235, Issue 2, p120
- ISSN
1018-8665
- Publication type
journal article
- DOI
10.1159/000493975