217 Calciphylaxis arising following bariatric surgery

Abstract

Calciphylaxis is a rare, highly morbid disease leading to vascular calcification and cutaneous necrosis, typically associated with end-stage renal disease (ESRD). While the pathogenesis and risk factors of calciphylaxis are poorly understood, some cases of calciphylaxis in patients who had previously undergone gastric bypass have been reported. The objective of this study is to report cases and describe an association between nutritional deficiencies in the context of bariatric surgery and calciphylaxis. Retrospective study in one large academic hospital that serves as a referral center for calciphylaxis in Boston, Massachusetts between 2012-2018 involving 11 patients who had bariatric surgery prior to calciphylaxis. Median time between bariatric surgery and calciphylaxis diagnosis was 2 years and 2 months, (range 7 months – 30 years). Parathyroid hormone levels were significantly higher in patients with ESRD compared to those with non-uremic calciphylaxis (p=0.036). Corrected calcium levels were significantly higher in patients who had malabsorptive compared to restrictive procedures (p=0.01). Limitations include retrospective nature, sample size, and missing weight loss data from remote bariatric surgical cases. Recognition of risk factors for calciphylaxis and careful evaluation of therapies for other comorbidities in patients who have undergone bariatric procedures is essential to improve outcomes for this rare but problematic disease.