{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T00:01:16Z","timestamp":1761177676211,"version":"build-2065373602"},"reference-count":0,"publisher":"Oxford University Press (OUP)","issue":"Supplement_3","license":[{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,21]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Calciphylaxis is a rare and severe medical condition primarily affecting people with advanced kidney disease, especially those on dialysis. In addition to the time on dialysis, risk factors include uncontrolled hyperparathyroidism, the use of certain medications such as vitamin K antagonist and corticosteroids, female gender, obesity, and diabetes. Calciphylaxis is associated with high morbidity and mortality and there are no specific treatments approved. Sodium thiosulfate is an off-label therapy that reduces tissue calcification. Hyperbaric oxygen therapy has also emerged as a complementary therapeutic option to improve tissue oxygenation and promote wound healing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case report<\/jats:title>\n                    <jats:p>We present two cases of calciphylaxis with similar approaches but different outcomes. The first case is about a 76-year-old woman with over 30 years of hemodialysis, uncontrolled secondary hyperparathyroidism and taking warfarin, who presented with painful skin lesions on her lower limbs that progressed over time. Biopsy confirmed the diagnosis of calciphylaxis. Dialysis strategy was optimized and warfarin was discontinued. Additionally, treatment with sodium thiosulfate and vitamin K agonist was initiated. The patient also started hyperbaric oxygen therapy. She continued to be followed by dermatology for wound care and pain management by anesthesiologists. Despite all treatments, the lesions progressed, leading to lower limb ischemia and amputation. The patient died 132 days after admission. The second case involved a 20-year-old woman with chronic kidney disease due to IgM nephropathy, on hemodialysis for about 3 years following a kidney transplant, and still on corticosteroid therapy and tacrolimus. She also had uncontrolled secondary hyperparathyroidism and her hemodialysis sessions were often shorter than the prescribed 4 hours. She presented with painful ulcers on her lower limbs, and biopsy confirmed calciphylaxis, similar to the first case. Dialysis was optimized and she also started sodium thiosulfate and hyperbaric oxygen therapy. The patient also maintained wound care according to dermatology recommendations and pain management adjustments from the anesthesia team. The patient showed progressive improvement in lesions. The patient completed a total of 22 hyperbaric oxygen therapy sessions and was discharged after 60 days of hospitalization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The disparate outcomes of the two patients are likely related to the more severe vascular disease in the first patient, due to age and longer duration on dialysis. Optimized wound care and pain management should be prioritized, requiring a multidisciplinary approach to enhance patient care. Sodium thiosulfate and hyperbaric oxygen therapy are off-label treatments that can be complementary and effective therapies and it should be considered on a case-by-case basis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ndt\/gfaf116.1395","type":"journal-article","created":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T11:04:06Z","timestamp":1761131046000},"source":"Crossref","is-referenced-by-count":0,"title":["#3601 Challenges in treatment approaches in calciphylaxis: insights from two case studies"],"prefix":"10.1093","volume":"40","author":[{"given":"Sandra Clementina Salgado","family":"Pereira","sequence":"first","affiliation":[{"name":"Unidade Local de Saude de Santo Antonio, Porto, Portugal"}]},{"given":"Jo\u00e3o Pedro Peixoto","family":"de Bessa e Silva","sequence":"additional","affiliation":[{"name":"Unidade Local de Saude de Santo Antonio, Porto, Portugal"}]},{"given":"Sofia","family":"Leit\u00e3o e Sousa","sequence":"additional","affiliation":[{"name":"Unidade Local de Saude de Santo Antonio, Porto, Portugal"}]},{"given":"Beatriz","family":"Silva","sequence":"additional","affiliation":[{"name":"Unidade Local de Saude de Santo Antonio, Porto, Portugal"}]},{"given":"Beatriz","family":"de Barros","sequence":"additional","affiliation":[{"name":"Unidade Local de Saude de Santo Antonio, Porto, Portugal"}]},{"given":"Andreia","family":"Campos","sequence":"additional","affiliation":[{"name":"Unidade Local de Saude de Santo Antonio, Porto, Portugal"}]},{"given":"Josefina","family":"Santos","sequence":"additional","affiliation":[{"name":"Unidade Local de Saude de Santo Antonio, Porto, Portugal"}]}],"member":"286","published-online":{"date-parts":[[2025,10,21]]},"container-title":["Nephrology Dialysis Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ndt\/article-pdf\/40\/Supplement_3\/gfaf116.1395\/64845170\/gfaf116.1395.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ndt\/article-pdf\/40\/Supplement_3\/gfaf116.1395\/64845170\/gfaf116.1395.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T11:28:21Z","timestamp":1761132501000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ndt\/article\/doi\/10.1093\/ndt\/gfaf116.1395\/8296298"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10]]},"references-count":0,"journal-issue":{"issue":"Supplement_3","published-online":{"date-parts":[[2025,10,21]]},"published-print":{"date-parts":[[2025,10,21]]}},"URL":"https:\/\/doi.org\/10.1093\/ndt\/gfaf116.1395","relation":{},"ISSN":["0931-0509","1460-2385"],"issn-type":[{"type":"print","value":"0931-0509"},{"type":"electronic","value":"1460-2385"}],"subject":[],"published-other":{"date-parts":[[2025,10]]},"published":{"date-parts":[[2025,10]]},"article-number":"gfaf116.1395"}}