Calciphylaxis - switching from HD to PD

My wife has been on HD for over two years. She began dialysis on an emergency basis in the hospital and soon thereafter had severe calciphylaxis to the extent that her survival was very much in doubt. She had other complications - including heart issues resulting in angiograms and insertion of stents, metatarsal amputations, diabetes, etc. She was in hospital/acute care hospital/skilled nursing facilities for 14 months.

She has now been home for a little over a year and is confined to a wheelchair. HD at the dialysis center three times per week.

At this point she very much wants to switch from HD to home PD. Some of the staff at the dialysis center don’t see any problem with this but the nephrologists are telling us that PD is out of the question because of her history of calciphylaxis.

Thoughts? Should we pursue PD of make the best of the current situation?

I am so sorry to hear that your wife had such a terrible complication. PD is slightly LESS dialysis than standard in-center HD (though it is more gentle), so I could see why her doctors might think this is unwise. But, there are 5 ways to do HD, and only 2 of them are in a clinic. Perhaps one of the others would be a better fit?

I’ve read that calciphylaxis is now called “calcific uremic arteriolopathy” in people with kidney disease. A Canadian article entitled “Multi-intervention management of calcific uremic arteriolopathy in 24 patients” states this about options for treatment: “Treatment consisted of intensive hemodialysis (>20h per week), sodium thiosulfate, wound care, analgesics and discontinuation of trigger medications including warfarin. Hyperbaric oxygen, cinacalcet, bisphosphonates and vitamin K were used in some cases.” Has she had these treatments? If not, you might want to ask her doctor if any of these treatments might help her.

As Dori said, getting more time on hemodialysis (some do HD while sleeping) might give her the amount of dialysis that helps this condition and give her better quality of life too. Some dialysis clinics offer in-center nocturnal HD, but most patients who do nocturnal HD do it at home.