Hyperbaric oxygen in the treatment of calciphylaxis: A case series and literature review

Aims: Calcific uraemic arteriolopathy (CUA) or calciphylaxis is most com monly seen in end-stage renal disease and is associated with significantmorbidity and mortality. The aim of this study was to determine whetherhyperbaric oxygen therapy (HBOT) is effective in healing calciphylaxislesions and to determine if there are any patient factors that can predictwound healing and patient survival.Methods: We identified by retrospective review all cases of CUA referred toour institution for treatment with HBOT. We documented the clinical andbiochemical parameters of this patient population, the size and distributionof the lesions as well as wound outcomes and patient survival followingtreatment.Results: A total 46 patients were identified with CUA associated with renalfailure. Of the 46 patients, only 34 received a full course of HBOT. Thebalance was deemed unsuitable for treatment or was unable to toleratetreatment and was palliated. Of the 34 patients that received a full course ofHBOT, 58% showed improvement in their wound scores, with more thanhalf of these patients having complete healing of their wounds. The balancedid not benefit from the therapy and had a very poor prognosis. Those thatbenefited from HBOT survived on average for more than 3 years. The onlyfactor significantly associated with improved wound healing and survivalwas diabetes.Conclusion: This retrospective analysis suggests a role for HBOT in the treat ment of CUA with more than half of the treated patients benefiting andsurviving for an average of more than 3 years.