Outcomes and mortality in calciphylaxis: A multicenter update - 28/06/25

Doi : 10.1016/j.jaad.2025.04.081

Colleen M. Glennon, MD ^a, Joyce Xia, MD ^b, Lindsay Strowd, MD ^c, Arturo R. Dominguez, MD ^d, Dylan Haynes, MD ^e, Jesse Keller, MD ^f, Joseph J. Locascio, PhD ^g, Robert G. Micheletti, MD ^h, Alex G. Ortega Loayza, MD ^f, Helena B. Pasieka, MD, MS ^i,^j, Michi M. Shinohara, MD ^k, Alice J. Tan, MD ^b, Sagar U. Nigwekar, MD, MMSc ^l,^m, Daniela Kroshinsky, MD, MPH ^a,^b,^⁎
^a Department of Dermatology, Duke University Medical Center, Durham, North Carolina
^b Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
^c Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
^d Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
^e Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
^f Department of Dermatology, Oregon Health & Science University, Portland, Oregon
^g Harvard Catalyst Biostatistical Consulting Group, Harvard Medical School, Boston, Massachusetts
^h Departments of Dermatology and Medicine, Perelman School of Medicine, Philadelphia, Pennsylvania
ⁱ Departments of Dermatology and Medicine, Uniformed Services University, Bethesda, Maryland
^j Department of Dermatology, MedStar Washington Hospital Center, Washington, District of Columbia
^k Department of Dermatology, University of Washington, Seattle, Washington
^l Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
^m Harvard Medical School, Boston, Massachusetts

^∗Correspondence to: Daniela Kroshinsky, MD, MPH, Department of Dermatology, Massachusetts General Hospital, 50 Staniford St, Ste 200, Boston, MA 02114.Department of DermatologyMassachusetts General Hospital50 Staniford StSte 200BostonMA02114

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Abstract

Background

Current understanding of calciphylaxis pathogenesis and treatment has advanced, with lower mortality.

Objective

To provide an updated report of calciphylaxis risk factors and outcomes in a large and diverse multicenter American validated cohort.

Methods

This was a multicenter, retrospective observational study across 6 major academic institutions. Adult patients with a clinical diagnosis of calciphylaxis from January 1, 2006, to December 31, 2022, were included.

Results

A total of 268 patients were included. Nephrogenic cases comprised 84.62% (209) of patients, while non-nephrogenic cases comprised 15.38% (38) of patients. Seventy-five patients (27.98%) died of calciphylaxis-related causes. One-year and 2-year disease-specific mortality was 28.88% and 29.92%, respectively. Penile lesions (penile vs distal: hazard ratio [HR]: 11.90, 95% CI: 2.44-44.85, P = .04), history of atrial fibrillation (HR: 2.41, 95% CI: 1.36-4.35, P < .01), and dialysis at diagnosis (HR: 2.02, 95% CI: 1.10-3.95, P = .03) were associated with higher mortality, while distal lesions were associated with lower mortality (distal vs proximal: HR: 0.34, 95% CI: 0.18-0.62, P = .04).

Limitations

Limitations of this study included its retrospective nature, limited representation of non-White or Black ethnicities, and outsized representation of 1 academic center.

Conclusion

While differences in survival emerged between institutions, the overall 1-year disease-specific mortality of 28.88% is lower than historic (45% to 80%), suggesting better patient outcomes with time.

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Key words : atrial fibrillation, calciphylaxis, lesion distribution, mortality, multicenter, nephrogenic, non-nephrogenic, outcomes, race

Abbreviations used : AF, CKD, ESRD, HR

Plan

Demographics and clinical history

Calciphylaxis-specific mortality

All-cause mortality

Discussion

Conclusion

	Drs Xia, Kroshinsky, and Author Glennon contributed equally to this article.
	Funding sources: None.
	Patient consent: Not applicable.
	IRB approval status: Reviewed and approved by Partners Health Institutional Review Board, #2018P001589.
	The opinions and assertions expressed herein are those of the author (H.B.P.) and do not reflect the official policy or position of the Uniformed Services University of the Health Sciences or the Department of Defense.