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Background <p>Ectopic calcification, especially in soft tissues such as subcutaneous adipose tissue, is a rare and serious complication in chronic kidney disease (CKD) patients. It is commonly associated with cardiovascular morbidity and mortality. This case report highlights the occurrence of multiple ectopic calcifications in a patient with end-stage renal disease (ESRD) on peritoneal dialysis, emphasizing the role of inflammatory cytokines in the pathogenesis of this condition. Early and appropriate intervention can facilitate partial reversibility, highlighting the importance of regular follow-ups and the optimization of prescriptions, particularly in ensuring intensified high-quality, goal-oriented dialysis.</p> Case presentation <p>A 68-year-old female patient with diabetic nephropathy had been on maintenance peritoneal dialysis for four years. She presented with multiple subcutaneous nodules, particularly in the abdomen and lower limbs, for over a month. Ultrasound and non-contrast CT imaging revealed hyperechoic lesions and calcifications in the subcutaneous tissue, along with vascular and kidney calcifications. Laboratory results indicated inadequate dialysis, hypocalcemia, hyperphosphatemia, and significantly elevated serum parathyroid hormone (PTH) and inflammatory cytokines, including IL-6. The biopsy of the subcutaneous nodule from the lower abdomen revealed calcification and inflammation, accompanied by pronounced IL-6 expression. Treatment included intensified automated peritoneal dialysis (APD) combined with icodextrin peritoneal dialysis solution for long-term retention in the abdomen, cinacalcet, phosphate binders, calcitriol, and nutritional support. After one month, the patient’s condition showed significant improvement, with reduced calcification confirmed by follow-up ultrasound.</p> Conclusions <p>This case underscores the rarity of subcutaneous adipose tissue calcification in ESRD patients and highlights the crucial role of inflammatory factors, particularly IL-6, in the development of ectopic calcifications. Early, targeted interventions, especially high-quality, goal-directed dialysis, can significantly improve outcomes, illustrating the importance of regular monitoring and tailored treatment in preventing and managing calcification in CKD patients.</p> Clinical trial number <p>Not applicable.</p>

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Multiple Ectopic calcifications in end-stage renal disease: role of inflammation and partial reversibility with intensified peritoneal dialysis-a case report

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年7月1日

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  • Shuai Hu,
  • Zejin Zhang,
  • Di Sun,
  • Yuqiang Chen,
  • Niansong Wang,
  • Tao Xu

摘要

Background

Ectopic calcification, especially in soft tissues such as subcutaneous adipose tissue, is a rare and serious complication in chronic kidney disease (CKD) patients. It is commonly associated with cardiovascular morbidity and mortality. This case report highlights the occurrence of multiple ectopic calcifications in a patient with end-stage renal disease (ESRD) on peritoneal dialysis, emphasizing the role of inflammatory cytokines in the pathogenesis of this condition. Early and appropriate intervention can facilitate partial reversibility, highlighting the importance of regular follow-ups and the optimization of prescriptions, particularly in ensuring intensified high-quality, goal-oriented dialysis.

Case presentation

A 68-year-old female patient with diabetic nephropathy had been on maintenance peritoneal dialysis for four years. She presented with multiple subcutaneous nodules, particularly in the abdomen and lower limbs, for over a month. Ultrasound and non-contrast CT imaging revealed hyperechoic lesions and calcifications in the subcutaneous tissue, along with vascular and kidney calcifications. Laboratory results indicated inadequate dialysis, hypocalcemia, hyperphosphatemia, and significantly elevated serum parathyroid hormone (PTH) and inflammatory cytokines, including IL-6. The biopsy of the subcutaneous nodule from the lower abdomen revealed calcification and inflammation, accompanied by pronounced IL-6 expression. Treatment included intensified automated peritoneal dialysis (APD) combined with icodextrin peritoneal dialysis solution for long-term retention in the abdomen, cinacalcet, phosphate binders, calcitriol, and nutritional support. After one month, the patient’s condition showed significant improvement, with reduced calcification confirmed by follow-up ultrasound.

Conclusions

This case underscores the rarity of subcutaneous adipose tissue calcification in ESRD patients and highlights the crucial role of inflammatory factors, particularly IL-6, in the development of ectopic calcifications. Early, targeted interventions, especially high-quality, goal-directed dialysis, can significantly improve outcomes, illustrating the importance of regular monitoring and tailored treatment in preventing and managing calcification in CKD patients.

Clinical trial number

Not applicable.