Research Viewpoints Calciphylaxis and Bariatric Surgery

Viewpoint On

Xia Joyce, Tan Alice J., Biglione Bianca, Cucka Bethany, Ko Lauren, Nguyen Emily D., Khoury Charbel C., Robinson Malcolm K., Nigwekar Sagar U., Kroshinsky Daniela: Nephrogenic Calciphylaxis Arising after Bariatric Surgery: A Case Series. American Journal of Nephrology DOI 10.1159/000531784

Calciphylaxis (Calcific Uremic Arteriopathy, CUA) is an uncommon but devastating and often fatal complication of ESKD and CKD. The “triggers” for the development of CUA are numerous and poorly understood. They include diabetes, obesity, warfarin use, hyperparathyroidism, hypercalcemia and hyperphosphatemia.

In a small case series (n=5) Xia ad colleagues add bariatric surgery for morbid obesity to this list of “triggers” for CUA. Five patients undergoing bariatric surgery, all with ESKD, developed CUA, one of whom died without resolution, despite aggressive therapy. Four had complete resolution, with therapy including IV and intra-lesional injection of sodium thiosulfate. It is possible that enteric oxalate reabsorption contributed to the CUA seen in these cases. Tissue stains for oxalate were not performed.

Although the benefits of bariatric surgery in patients with morbid obesity and ESKD likely outweighed the risks of CUA, careful attention to the multitude of possible “triggers” in these patients seems warranted. Seems like good advice.