. 2024 Jan 18;9(4):951-959.

doi: 10.1016/j.ekir.2024.01.026. eCollection 2024 Apr.

Calciphylaxis Episodes in the Australia and New Zealand Dialysis and Transplant Registry

Nigel D Toussaint^{1

2}, Christopher E Davies^{3

4}, Elisa Bongetti⁵, Irene Ruderman^{1

2}, Grahame J Elder^{6

7

8

9}, Carmel M Hawley^{10

11}, Rathika Krishnasamy¹², Matthew A Roberts¹³, Meg J Jardine^{14

15

16}, Janak R De Zoysa^{17

18}, Stephen P McDonald^{3

4

19}

Affiliations

¹ Department of Nephrology, The Royal Melbourne Hospital, Parkville, Australia.
² Department of Medicine (RMH), University of Melbourne, Parkville, Australia.
³ Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia.
⁴ Australia and New Zealand Dialysis and Transplant Registry, South Australian Health and Medical Research Institute, Adelaide, Australia.
⁵ Department of Nephrology, Monash Medical Centre, Clayton, Australia.
⁶ School of Medicine, University of Notre Dame, Sydney, Australia.
⁷ Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
⁸ Skeletal Biology Program, Garvan Institute of Medical Research, Darlinghurst, Australia.
⁹ Department of Nephrology, Westmead Hospital, Sydney, Australia.
¹⁰ Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.
¹¹ Translational Research Institute, Brisbane, Australia.
¹² Department of Nephrology, Sunshine Coast Hospital University Hospital, Birtinya, Australia.
¹³ Eastern Health Clinical School, Monash University, Box Hill, Australia.
¹⁴ NHMRC Clinical Trials Centre, University of Sydney New South Wales, Australia.
¹⁵ Department of Nephrology, Concord Repatriation General Hospital, Sydney, Australia.
¹⁶ The George Institute for Global Health, UNSW, Sydney Australia.
¹⁷ Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand.
¹⁸ Te Whatu Ora Waitemata, Auckland, New Zealand.
¹⁹ Central and Northern Adelaide Renal and Transplantation Services, Royal Adelaide Hospital, Adelaide, Australia.

PMID: 38765561
PMCID: PMC11101771
DOI: 10.1016/j.ekir.2024.01.026

Calciphylaxis Episodes in the Australia and New Zealand Dialysis and Transplant Registry

Nigel D Toussaint et al. Kidney Int Rep. 2024.

. 2024 Jan 18;9(4):951-959.

doi: 10.1016/j.ekir.2024.01.026. eCollection 2024 Apr.

Authors

Affiliations

¹ Department of Nephrology, The Royal Melbourne Hospital, Parkville, Australia.
² Department of Medicine (RMH), University of Melbourne, Parkville, Australia.
³ Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia.
⁴ Australia and New Zealand Dialysis and Transplant Registry, South Australian Health and Medical Research Institute, Adelaide, Australia.
⁵ Department of Nephrology, Monash Medical Centre, Clayton, Australia.
⁶ School of Medicine, University of Notre Dame, Sydney, Australia.
⁷ Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
⁸ Skeletal Biology Program, Garvan Institute of Medical Research, Darlinghurst, Australia.
⁹ Department of Nephrology, Westmead Hospital, Sydney, Australia.
¹⁰ Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.
¹¹ Translational Research Institute, Brisbane, Australia.
¹² Department of Nephrology, Sunshine Coast Hospital University Hospital, Birtinya, Australia.
¹³ Eastern Health Clinical School, Monash University, Box Hill, Australia.
¹⁴ NHMRC Clinical Trials Centre, University of Sydney New South Wales, Australia.
¹⁵ Department of Nephrology, Concord Repatriation General Hospital, Sydney, Australia.
¹⁶ The George Institute for Global Health, UNSW, Sydney Australia.
¹⁷ Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand.
¹⁸ Te Whatu Ora Waitemata, Auckland, New Zealand.
¹⁹ Central and Northern Adelaide Renal and Transplantation Services, Royal Adelaide Hospital, Adelaide, Australia.

PMID: 38765561
PMCID: PMC11101771
DOI: 10.1016/j.ekir.2024.01.026

Abstract

Introduction: Calciphylaxis is a rare disorder associated with significant morbidity and mortality. Data registries are an invaluable source of information for rare diseases. We reviewed cases of calciphylaxis recorded in the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) and evaluated associations and outcomes of this condition.

Methods: Data was obtained on all cases of calciphylaxis reported between 2019 and 2022 in Australian and New Zealand patients on kidney replacement therapy (KRT). This cohort was compared to all patients in the registry who received KRT from 2019 to 2022 without an episode of calciphylaxis. Cox proportional hazards regression including a time-varying covariate for calciphylaxis episode was conducted for mortality with models restricted to patients on dialysis only.

Results: From 2019 to 2022, 333 patients had calciphylaxis episodes reported. Overall incidence rate for patients on dialysis was 4.5 (4.1-5.1) episodes per 1000 patient-years on dialysis. Median age was 63 (interquartile range [IQR]: 55-73) years, 54% were female, 66% had diabetes, 59% were obese (body mass index [BMI] ≥ 30 kg/m²) and 77% were receiving hemodialysis (HD) treatment. Compared to patients without calciphylaxis (n = 46,526), patients with calciphylaxis were more likely to be older, female, and have diabetes, greater BMI, coronary artery, and peripheral vascular disease. The median time to calciphylaxis was 3.2 (IQR: 0.9-6.7) years after KRT commencement. Half of the patients with calciphylaxis died by 12 months from diagnosis. Adjusted hazard ratio (HR) of mortality for patients on dialysis with calciphylaxis <1 year and 1 to 4 years after an episode was 5.8 (4.9-6.9) and 1.5 (1.0-2.1), respectively compared to patients on dialysis without calciphylaxis.

Conclusion: Calciphylaxis is a rare but life-threatening condition in people on KRT with the greatest mortality burden within 12 months of diagnosis.

Keywords: calciphylaxis; dialysis; kidney failure; kidney replacement therapy; mineral metabolism; registry.

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Figures

**Figure 1**
Incidence rate ratios using multivariate mixed effects Poisson model for incidence. BMI, body mass index; HD, hemodialysis; IRR, incidence rate ratio; KRT, kidney replacement therapy; PD, peritoneal dialysis; NZ, New Zealand; Australia States and Territories [ACT, Australian Capital Territory; NSW, New South Wales; NT, Northern Territory; QLD, Queensland; SA, South Australia; TAS, Tasmania; VIC, Victoria; WA, Western Australia]. ^#43,916 patients included as missing data in some variables.

**Figure 2**
Unadjusted Kaplan-Meier curve for patient survival from the first calciphylaxis episode.

See this image and copyright information in PMC

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Calciphylaxis Episodes in the Australia and New Zealand Dialysis and Transplant Registry

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