BACKGROUND Calcific Uremic Arteriolopathy (CUA) is a rare disease, causing painful skin ulcers in patients with end stage renal disease. Recommendations for CUA management and treatment are lacking. METHODS We conducted a retrospective cohort study on CUA cases identified in western France, in order to describe its management and outcome in average clinical practices. Selection was based on the Hayashi diagnosis criteria (2013) extended to patients with eGFR < 30 mL/min/1.73m2. Dialyzed CUA cases were compared with 2 controls, matched for age, gender, region of treatment and time period. RESULTS Eighty-nine CUA cases were identified between 2006 and 2016, including 19 non dialyzed and 70 dialyzed patients. Females with obesity (55.1%) were predominant. Bone mineral disease abnormalities, inflammation and malnutrition (weight loss, serum albumin decrease) preceded CUA onset for 6 months. The multimodal treatment strategy included wound care (98.9%), antibiotherapy (77.5%), discontinuation of Vitamin K antagonists (VKA) (70.8%) and intravenous sodium thiosulfate (65.2%). 40.4% of the patients died within the year after lesion onset, mainly under palliative care. Surgical debridement, distal CUA, localization to the lower limbs and non calcium-based phosphate binders were associated with better survival. Risks factors of developing CUA among dialysis patients were obesity, VKA, weight loss, serum albumin decrease or high serum phosphate in the 6 months before lesion onset. CONCLUSION CUA involved mainly obese patients under VKA. Malnutrition and inflammation preceded the onset of skin lesions and could be warning signs among dialysis patients at risk. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT02854046, registered August 3, 2016.

中文翻译：

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法国慢性肾脏病患者的骨灰质病流行病学，危险因素，治疗和生存：病例对照研究。

背景技术尿路钙化性尿毒症（CUA）是一种罕见疾病，在患有晚期肾病的患者中引起痛苦的皮肤溃疡。缺乏关于CUA管理和治疗的建议。方法我们对法国西部发现的CUA病例进行了回顾性队列研究，以描述其在一般临床实践中的管理和结果。选择基于Hayashi诊断标准（2013），适用于eGFR <30 mL / min / 1.73m2的患者。将透析的CUA病例与2名对照进行比较，根据年龄，性别，治疗区域和时间段进行匹配。结果在2006年至2016年期间，鉴定出89例CUA病例，包括19例非透析患者和70例透析患者。女性以肥胖症为主（55.1％）。骨矿物质疾病异常，炎症和营养不良（体重减轻，血清白蛋白下降）在CUA发作之前6个月。多模式治疗策略包括伤口护理（98.9％），抗生物疗法（77.5％），停用维生素K拮抗剂（VKA）（70.8％）和静脉注射硫代硫酸钠（65.2％）。40.4％的患者在发病后一年内死亡，主要在姑息治疗下死亡。手术清创术，远端CUA，定位于下肢和非钙基磷酸盐结合剂可提高生存率。透析前6个月，透析患者发生CUA的危险因素为肥胖，VKA，体重减轻，血清白蛋白降低或血清高磷酸盐。结论CUA主要涉及VKA下的肥胖患者。营养不良和炎症先于皮肤损害发作，并且可能是处于危险中的透析患者的警告信号。