Outcomes and mortality in calciphylaxis: A multicenter update

Colleen M. Glennon; Joyce Xia; Lindsay Strowd; Arturo R. Dominguez; Dylan Haynes; Jesse Keller; Joseph J. Locascio; Robert G. Micheletti; Alex G. Ortega Loayza; Helena B. Pasieka; Michi M. Shinohara; Alice J. Tan; Sagar U. Nigwekar; Daniela Kroshinsky

doi:10.1016/j.jaad.2025.04.081

Outcomes and mortality in calciphylaxis: A multicenter update

Colleen M. Glennon, Joyce Xia, Lindsay Strowd, Arturo R. Dominguez, Dylan Haynes, Jesse Keller, Joseph J. Locascio, Robert G. Micheletti, Alex G. Ortega Loayza, Helena B. Pasieka, Michi M. Shinohara, Alice J. Tan, Sagar U. Nigwekar, Daniela Kroshinsky^*

^*Corresponding author for this work

Dermatology

Research output: Contribution to journal › Article › peer-review

1 Scopus citations

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.

Original language	English
Pages (from-to)	966-974
Number of pages	9
Journal	Journal of the American Academy of Dermatology
Volume	93
Issue number	4
DOIs	https://doi.org/10.1016/j.jaad.2025.04.081
State	Published - Oct 2025

Keywords

Adult
Aged
Calciphylaxis/mortality
Female
Humans
Male
Middle Aged
Renal Dialysis/statistics & numerical data
Retrospective Studies
Risk Factors
United States/epidemiology

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10.1016/j.jaad.2025.04.081

Cite this

Glennon, C. M., Xia, J., Strowd, L., Dominguez, A. R., Haynes, D., Keller, J., Locascio, J. J., Micheletti, R. G., Ortega Loayza, A. G., Pasieka, H. B., Shinohara, M. M., Tan, A. J., Nigwekar, S. U., & Kroshinsky, D. (2025). Outcomes and mortality in calciphylaxis: A multicenter update. Journal of the American Academy of Dermatology, 93(4), 966-974. https://doi.org/10.1016/j.jaad.2025.04.081

@article{472fd8731e9941318f476afe7eec6639,

title = "Outcomes and mortality in calciphylaxis: A multicenter update",

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.",

keywords = "Adult, Aged, Calciphylaxis/mortality, Female, Humans, Male, Middle Aged, Renal Dialysis/statistics & numerical data, Retrospective Studies, Risk Factors, United States/epidemiology",

author = "Glennon, {Colleen M.} and Joyce Xia and Lindsay Strowd and Dominguez, {Arturo R.} and Dylan Haynes and Jesse Keller and Locascio, {Joseph J.} and Micheletti, {Robert G.} and {Ortega Loayza}, {Alex G.} and Pasieka, {Helena B.} and Shinohara, {Michi M.} and Tan, {Alice J.} and Nigwekar, {Sagar U.} and Daniela Kroshinsky",

note = "Copyright {\textcopyright} 2025. Published by Elsevier Inc.",

year = "2025",

month = oct,

doi = "10.1016/j.jaad.2025.04.081",

language = "English",

volume = "93",

pages = "966--974",

journal = "Journal of the American Academy of Dermatology",

issn = "0190-9622",

publisher = "Elsevier Inc.",

number = "4",

}

Glennon, CM, Xia, J, Strowd, L, Dominguez, AR, Haynes, D, Keller, J, Locascio, JJ, Micheletti, RG, Ortega Loayza, AG, Pasieka, HB, Shinohara, MM, Tan, AJ, Nigwekar, SU & Kroshinsky, D 2025, 'Outcomes and mortality in calciphylaxis: A multicenter update', Journal of the American Academy of Dermatology, vol. 93, no. 4, pp. 966-974. https://doi.org/10.1016/j.jaad.2025.04.081

TY - JOUR

T1 - Outcomes and mortality in calciphylaxis

T2 - A multicenter update

AU - Glennon, Colleen M.

AU - Xia, Joyce

AU - Strowd, Lindsay

AU - Dominguez, Arturo R.

AU - Haynes, Dylan

AU - Keller, Jesse

AU - Locascio, Joseph J.

AU - Micheletti, Robert G.

AU - Ortega Loayza, Alex G.

AU - Pasieka, Helena B.

AU - Shinohara, Michi M.

AU - Tan, Alice J.

AU - Nigwekar, Sagar U.

AU - Kroshinsky, Daniela

PY - 2025/10

Y1 - 2025/10

N2 - 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.

AB - 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.

KW - Adult

KW - Aged

KW - Calciphylaxis/mortality

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Renal Dialysis/statistics & numerical data

KW - Retrospective Studies

KW - Risk Factors

KW - United States/epidemiology

UR - http://www.scopus.com/inward/record.url?scp=105009358591&partnerID=8YFLogxK

U2 - 10.1016/j.jaad.2025.04.081

DO - 10.1016/j.jaad.2025.04.081

M3 - Article

C2 - 40409721

AN - SCOPUS:105009358591

SN - 0190-9622

VL - 93

SP - 966

EP - 974

JO - Journal of the American Academy of Dermatology

JF - Journal of the American Academy of Dermatology

IS - 4

ER -