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Background An echocardiography-derived calcium score (ECS) has been shown to predict CV mortality in the general population but has not been utilized in the dialysis population. Methods We conducted a prospective cohort study including 125 prevalent PD patients. Two blinded and independent echocardiographers determined the ECS for each subject at baseline. The primary outcome was the three-point major adverse cardiovascular events (MACE) which is a composite outcome comprising CV Death, non-fatal myocardial infarction and non-fatal stroke. The secondary outcome was all-cause mortality. Results The mean age was 61 ± 13 years. The median follow-up duration was 40 months (range 1-50). Diabetes mellitus (DM) occurred in 76 (60.8%) of the subjects. The median duration of dialysis was 32 (IQR 16-54) months. The incidences of MACE and all-cause mortality were 13.0 per 100 patient-years and 18.3 per 100 patient-years. Multivariate Cox regression analysis identified the following 3 independent predictors of MACE: ECS (HR 1.253 / unit increase in ECS, 95% CI 1.014-1.547, p = 0.036), DM (HR 2.467, 95% CI 1.014-6.005, p = 0.047) and pre-existing CVD (HR 2.441, 95% CI 1.261-4.728, p = 0.008); and the following 2 predictors of all-cause mortality: pre-existing CVD (HR 2.156, 95% CI 1.251-3.714, p = 0.006) and serum albumin (HR 0.887 / g/L increase in serum albumin, 95% CI 0.839-0.937, p Conclusion The ECS appears to be a significant predictor of MACE in PD patients independently of DM and pre-existing CVD. This article is protected by copyright. All rights reserved.

Tumoral calcinosis is a rare but debilitating condition that can affect dialysis patients. Optimal management is largely unknown. We report the clinical course, treatment, and outcome of a peritoneal dialysis (PD) patient who developed tumoral calcinosis refractory to conventional treatment but improved with teriparatide therapy. A 26-year-old lady on PD for 2 years presented to us with tumoral calcinosis involving bilateral hands. Response to surgical excision, parathyroidectomy, and conversion to hemodialysis failed to result in sustained remission, and tumoral calcinosis progressed. After total parathyroidectomy, the patient had transient but partial remission in which her calcinosis deposits remained but were asymptomatic without pain or clinical signs of inflammation. However, she later experienced a relapse with involvement of the left elbow, right shoulder, right hip, and right thigh. Tumoral calcinosis remained uncontrolled resulting in debilitation, likely attributable to poor calcium and phosphate control because of adynamic bone disease after parathyroidectomy despite treatment of superimposed tuberculosis and therapy with sodium thiosulphate and pamidronic acid. Clinical improvement was however evident after the use of teriparatide. Asymptomatic hypocalcemia occurred after teriparatide therapy but resolved after 2 months. In conclusion, teriparatide appears to be useful for treating tumoral calcinosis in the presence of adynamic bone disease. Hypocalcemia can occur in the initial months of therapy.

Background: The hungry bone syndrome (HBS) is a well described phenomenon occurring shortly after parathyroidectomy characterized by rapid bone formation with concomitant hypocalcemia, hypophosphatemia and hypomagnesemia requiring intensive management. Recurrent HBS occurring in isolation from parathyroidectomy has not been reported.Case presentation: We describe a case of recurrent HBS in a kidney transplant recipient (KTR) developing years after parathyroidectomy. The KTR was a 49 year-old lady who had undergone successful total parathyroidectomy without re-implantation 14 years prior and cadaveric kidney transplantation 12 years prior. She had a stable creatinine level of 220μmol/L and an estimated glomerular filtration rate (eGFR) of 20 mL/min-1.73m2. She presented to us with severe hypercalcemia, likely a result of excessive calcium and vitamin D supplementation, and acute kidney injury. Serum creatinine, calcium, phosphate, magnesium, alkaline phosphatase (ALP), and intact parathyroid hormone (iPTH) levels on admission were 743μmol/L, 4.8 mmol/L, 1.8 mmol/L, 0.75 mmol/L, 48IU/L and

Background The optimal management of calciphylaxis in kidney transplant recipients (KTRs) is uncertain. Case presentation We report 2 cases of refractory calciphylaxis in KTRs who suffered from persistent secondary hyperparathyroidism. They failed initial therapy with sodium thiosulphate but responded to treatment with bisphosphonates. No adverse events were noted with bisphosphonate therapy. Conclusion Bisphosphonates appear to be an effective therapy for KTRs with calciphylaxis who cannot tolerate or respond poorly to STS, particularly if they have persistent hyperparathyroidism post-transplantation.