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Poster
CS-006
Utilization of Hyperbaric Oxygen Therapy in the Successful Treatment of Calcific Uremic Arteriolopathy (Calciphylaxis)
Introduction: Calcific Uremic Arteriolopathy (Calciphylaxis) usually occurs in patients with end stage renal disease and carries a high morbidity and mortality rate. The disease is characterized by the calcification of capillaries and arterioles in the dermis and/or subcutaneous adipose tissue. There is the development of reduced arterial blood flow leading to skin necrosis with extremely painful ischemic lesions (ulceration carries a mortality of > 80%). Usual etiology of mortality involves the development of infection. The standard of care has been:
Trial of Sodium Thiosulfate
Medication adjustments (discontinuing - Vitamin D, Calcium Supplements and Warfarin)
Medical management of hyperphosphatemia and hyperparathyroidism
As needed surgical debridement of infected lesions and treatment of infection
Methods: PRIMARY TREATMENT:Hyperbaric oxygen therapy implemented for 30 sessions:2.4 ATA x 90 minutes with 100% oxygen with two (5 min) air breaksSECONDARY TREATMENTS
non contact real-time fluorescence wound imaging for bacteria presence and location
non contact near infrared spectroscopy
continuous diffusion of oxygen therapy - targeted on larger lesions
Intravenous Sodium Thiosulfate given during hemodialysis
Initial enzymatic debridement using Collagenase
Sharp surgical debridement
As needed systemic and/or topical antibiotic therapy
Pain medications
Results:The multiple skin ulcerations that were caused by Calcific Uremic Arteriolopathy (Calciphylaxis) resolved. Additional findings included:
Non contact real time fluorescence wound imaging no longer showed any bacterial presence
Non contact near infrared spectroscopy showed decreased inflammation/hyperemia with adequate oxygenation and microcirculation in the prior skin ulcerations
Complete resolution of pain
Discussion: The ICD-10 codes used to bill Medicare (Noridian) for the treatment of hyperbaric oxygen therapy were:
I70.242 - Atherosclerosis of native arteries of left leg with ulceration of calf
I70.235 - Atherosclerosis of native arteries of right leg with ulceration of other part of foot
I70.232 - Atherosclerosis of native arteries of right leg with ulceration of calf
E83.59 - Other disorders of calcium metabolism
HOWEVER, MEDICARE ULTIMATELY DENIED PAYMENT FOR THE PATIENT'S TREATMENT. The patient (and family) were able to pay out of pocket for the above treatment.There needs to be more clinical trials to validate the benefit of hyperbaric oxygen therapy in the treatment of Calcific Uremic Arteriopathy.References:An J, Devaney B, Ooi KY, Ford S, Frawley G, Menahem S. Hyperbaric oxygen in the treatment of calciphylaxis: A case series and literature review. Nephrology (Carlton). 2015 Jul;20(7):444-50. doi: 10.1111/nep.12433. PMID: 25707425.
Martin R. Mysterious calciphylaxis: wounds with eschar--to debride or not to debride? Ostomy Wound Manage. 2004 Apr;50(4):64-6, 68-70; discussion 71. PMID: 15259802.
PubMed
Hyperbaric oxygen in the treatment of calciphylaxis: A case series and literature review.
An J, Devaney B, Ooi KY, Ford S, Frawley G, Menahem S SO Nephrology (Carlton). 2015;20(7):444
UpToDate - Calciphylaxis (calcific uremic arteriolopathy), Sagar U Nigwekar, MD, MMScRavi I Thadhani, MD, MPH SECTION EDITOR:L Darryl Quarles, MD DEPUTY EDITOR:Eric N Taylor, MD, MSc, FASN: Apr 2024. topic last updated: Feb 16, 2024.