---
title: "Calciphylaxis (CUA) in Chronic Kidney Disease: Pathomechanisms and Key Risk Factors"
id: "pubmed-42572798"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42572798"
content_type: "clinical_feed_article"
specialty: "Pharmacology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42572798/"
doi: "10.1080/0886022X.2026.2710397"
published_at: "2026-08-10T12:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Calciphylaxis (CUA) in Chronic Kidney Disease: Pathomechanisms and Key Risk Factors
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42572798
- **Specialty:** [Pharmacology](https://medichelpline.com/clinical-feed/pharmacology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42572798/)
- **DOI:** [10.1080/0886022X.2026.2710397](https://doi.org/10.1080%2F0886022X.2026.2710397)
- **Published At:** 2026-08-10T12:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This systematic review examined factors associated with **calcific uremic arteriolopathy (CUA)** in patients with **chronic kidney disease (CKD)** by comparing CKD patients with and without CUA. - Literature searches of EMBASE and PubMed up to February 2026 screened 2,374 records; 35 studies met inclusion criteria for comparative analysis. - Consistently reported risk factors included low serum **albumin**, elevated **alkaline phosphatase**, **diabetes**, higher body mass index, female sex, and use of **vitamin K antagonists (VKA)**. - Biochemical and histologic features linked to CUA were increased calcium–phosphate product and presence of **calcification and thrombosis** in subcutaneous small arteries. - Factors likely associated with CUA, though less consistently reported, included anemia, reduced dialysis adequacy, peritoneal dialysis modality, systemic inflammation, arterial hypertension, smoking, and hepatobiliary disease. - Findings on **matrix Gla protein** alterations, parathyroid hormone, and hypercoagulability were inconsistent or ambiguous across studies. - The authors note a lack of a standardized system for CUA skin biopsy evaluation, limiting comparability of pathologic data. - The review highlights major pathogenic themes: disturbances in mineral metabolism, vascular calcification pathways, thrombosis, and systemic factors—while identifying several areas where robust mechanistic data are missing. - The review underscores the need for improved standardized diagnostic pathology and further research to clarify causal pathways and potential preventive targets in CKD patients at risk for CUA.
## Clinical Analysis & Structured Key Points
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Epub 2026 Aug 10. # Calciphylaxis in chronic kidney disease: a systematic review of pathomechanisms and risk factors for calcific uremic arteriolopathy [Cecilie Søndergaard](https://pubmed.ncbi.nlm.nih.gov/?term=S%C3%B8ndergaard+C&cauthor_id=42572798)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42572798/#full-view-affiliation-1 "Department of Clinical Research, University of Southern Denmark, Odense, Denmark.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42572798/#full-view-affiliation-2 "Department of Nephrology, Odense University Hospital, Odense, Denmark."), [Subagini Nagarajah](https://pubmed.ncbi.nlm.nih.gov/?term=Nagarajah+S&cauthor_id=42572798)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42572798/#full-view-affiliation-1 "Department of Clinical Research, University of Southern Denmark, Odense, Denmark.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42572798/#full-view-affiliation-2 "Department of Nephrology, Odense University Hospital, Odense, Denmark."), [Jianlin Shen](https://pubmed.ncbi.nlm.nih.gov/?term=Shen+J&cauthor_id=42572798)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42572798/#full-view-affiliation-3 "Department of Orthopedics, Putian University, Putian, China."), [Else-Marie Bladbjerg](https://pubmed.ncbi.nlm.nih.gov/?term=Bladbjerg+EM&cauthor_id=42572798)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42572798/#full-view-affiliation-4 "Unit for Thrombosis Research, Department of Clinical Biochemistry, University Hospital of Southern Denmark, Esbjerg, Denmark.")[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42572798/#full-view-affiliation-5 "Department of Regional Health Research, University of Southern Denmark, Odense, Denmark."), [Alexandra Scholze](https://pubmed.ncbi.nlm.nih.gov/?term=Scholze+A&cauthor_id=42572798)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42572798/#full-view-affiliation-1 "Department of Clinical Research, University of Southern Denmark, Odense, Denmark.")[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42572798/#full-view-affiliation-6 "Department of Cardiac, Thoracic, and Vascular Surgery, Odense University Hospital, Odense, Denmark.") Affiliations Expand ### Affiliations * 1 Department of Clinical Research, University of Southern Denmark, Odense, Denmark. * 2 Department of Nephrology, Odense University Hospital, Odense, Denmark. * 3 Department of Orthopedics, Putian University, Putian, China. * 4 Unit for Thrombosis Research, Department of Clinical Biochemistry, University Hospital of Southern Denmark, Esbjerg, Denmark. * 5 Department of Regional Health Research, University of Southern Denmark, Odense, Denmark. * 6 Department of Cardiac, Thoracic, and Vascular Surgery, Odense University Hospital, Odense, Denmark. * PMID: **42572798** * DOI: [ 10.1080/0886022X.2026.2710397 ](https://doi.org/10.1080/0886022x.2026.2710397) Item in Clipboard Review # Calciphylaxis in chronic kidney disease: a systematic review of pathomechanisms and risk factors for calcific uremic arteriolopathy Cecilie Søndergaard et al. Ren Fail. 2026 Dec. Show details Display options Display options Format Abstract PubMed PMID Ren Fail Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Ren+Fail%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Ren+Fail%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42572798/) . 2026 Dec;48(1):2710397. doi: 10.1080/0886022X.2026.2710397. Epub 2026 Aug 10. ### Authors [Cecilie Søndergaard](https://pubmed.ncbi.nlm.nih.gov/?term=S%C3%B8ndergaard+C&cauthor_id=42572798)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42572798/#short-view-affiliation-1 "Department of Clinical Research, University of Southern Denmark, Odense, Denmark.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42572798/#short-view-affiliation-2 "Department of Nephrology, Odense University Hospital, Odense, Denmark."), [Subagini Nagarajah](https://pubmed.ncbi.nlm.nih.gov/?term=Nagarajah+S&cauthor_id=42572798)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42572798/#short-view-affiliation-1 "Department of Clinical Research, University of Southern Denmark, Odense, Denmark.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42572798/#short-view-affiliation-2 "Department of Nephrology, Odense University Hospital, Odense, Denmark."), [Jianlin Shen](https://pubmed.ncbi.nlm.nih.gov/?term=Shen+J&cauthor_id=42572798)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42572798/#short-view-affiliation-3 "Department of Orthopedics, Putian University, Putian, China."), [Else-Marie Bladbjerg](https://pubmed.ncbi.nlm.nih.gov/?term=Bladbjerg+EM&cauthor_id=42572798)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42572798/#short-view-affiliation-4 "Unit for Thrombosis Research, Department of Clinical Biochemistry, University Hospital of Southern Denmark, Esbjerg, Denmark.")[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42572798/#short-view-affiliation-5 "Department of Regional Health Research, University of Southern Denmark, Odense, Denmark."), [Alexandra Scholze](https://pubmed.ncbi.nlm.nih.gov/?term=Scholze+A&cauthor_id=42572798)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42572798/#short-view-affiliation-1 "Department of Clinical Research, University of Southern Denmark, Odense, Denmark.")[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42572798/#short-view-affiliation-6 "Department of Cardiac, Thoracic, and Vascular Surgery, Odense University Hospital, Odense, Denmark.") ### Affiliations * 1 Department of Clinical Research, University of Southern Denmark, Odense, Denmark. * 2 Department of Nephrology, Odense University Hospital, Odense, Denmark. * 3 Department of Orthopedics, Putian University, Putian, China. * 4 Unit for Thrombosis Research, Department of Clinical Biochemistry, University Hospital of Southern Denmark, Esbjerg, Denmark. * 5 Department of Regional Health Research, University of Southern Denmark, Odense, Denmark. * 6 Department of Cardiac, Thoracic, and Vascular Surgery, Odense University Hospital, Odense, Denmark. * PMID: **42572798** * DOI: [ 10.1080/0886022X.2026.2710397 ](https://doi.org/10.1080/0886022x.2026.2710397) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract Calcific uremic arteriolopathy (CUA) is a rare, severe condition affecting patients with chronic kidney disease (CKD). The etiology of CUA is unclear. Here, we aimed to identify factors associated with its development. We reviewed the existing evidence on its pathomechanisms and risk factors. We searched EMBASE and PubMed up to February 2026, reviewing all studies that would facilitate a comparison of CKD patients with and without CUA. Of 2374 screened publications, 35 met our inclusion criteria. The factors that consistently emerged related to CUA were decreased albumin, higher alkaline phosphatase, diabetes, increased body mass index, female sex, vitamin K antagonist (VKA) use, increased calcium phosphate product, and calcification and thrombosis in subcutaneous small arteries. Factors that appeared to be likely associated with CUA were anemia, suboptimal dialysis efficiency, peritoneal dialysis, inflammation, arterial hypertension, smoking, and hepatobiliary disease. Findings on matrix Gla protein alterations implicated in mediating VKA effects, parathyroid hormone, and hypercoagulability were ambiguous in our literature analyses. In addition, we found that a standardized system for CUA skin biopsy evaluation is lacking. In summary, our review delineates the major risk factors and pathogenic parameters associated with CUA development. Furthermore, it underscores areas in which robust data on CUA pathomechanisms are lacking. **Keywords:** CKD; hemodialysis; inflammation; nephrogenic calciphylaxis; vascular calcification. ## Plain language summary Calcific uremic arteriolopathy (CUA), also known as calciphylaxis, is a rare but serious condition that can occur in people with advanced kidney disease. It causes calcium to build up in small blood vessels, reducing blood flow and leading to painful skin wounds.To better understand why CUA develops, we reviewed studies comparing people with chronic kidney disease who did and did not develop the condition. We found that several factors were commonly linked to a higher risk of CUA, including diabetes, higher body weight, low blood albumin levels, abnormal calcium and phosphate levels, use of certain blood-thinning medicines (vitamin K antagonists such as warfarin), and being female. Other possible risk factors included anemia, inflammation, smoking, high blood pressure, and less effective dialysis treatment.Our findings suggest that CUA develops through a combination of factors affecting blood vessels, mineral balance, and overall health. More research is needed to understand exactly how these factors contribute to the disease and whether they can help identify patients at risk before symptoms appear. This could improve early detection, prevention, and treatment of this serious condition. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Similar articles * [ Risk Factors Associated With the Development of Calciphylaxis in Patients With Chronic Kidney Disease: A Systematic Review. ](https://pubmed.ncbi.nlm.nih.gov/39776750/) Ogah CO, Mohammed H, Gabra IM, Halawa N, Naeem S, Khan S.Ogah CO, et al.Cureus. 2024 Dec 8;16(12):e75314. doi: 10.7759/cureus.75314. eCollection 2024 Dec.Cureus. 2024.PMID: 39776750Free PMC article.Review. * [ Calciphylaxis epidemiology, risk factors, treatment and survival among French chronic kidney disease patients: a case-control study. ](https://pubmed.ncbi.nlm.nih.gov/32101140/) Gaisne R, Péré M, Menoyo V, Hourmant M, Larmet-Burgeot D.Gaisne R, et al.BMC Nephrol. 2020 Feb 26;21(1):63. doi: 10.1186/s12882-020-01722-y.BMC Nephrol. 2020.PMID: 32101140Free PMC article. * [ Localization, Morphologic Features, and Chemical Composition of Calciphylaxis-Related Skin Deposits in Patients With Calcific Uremic Arteriolopathy. ](https://pubmed.ncbi.nlm.nih.gov/31116362/) Colboc H, Moguelet P, Bazin D, Carvalho P, Dillies AS, Chaby G, Maillard H, Kottler D, Goujon E, Jurus C, Panaye M, Frochot V, Letavernier E, Daudon M, Lucas I, Weil R, Courville P, Monfort JB, Chasset F, Senet P; Groupe Angio-Dermatologie of the French Society of Dermatology.Colboc H, et al.JAMA Dermatol. 2019 Jul 1;155(7):789-796. doi: 10.1001/jamadermatol.2019.0381.JAMA Dermatol. 2019.PMID: 31116362Free PMC article. * [ Folic acid supplementation and malaria susceptibility and severity among people taking antifolate antimalarial drugs in endemic areas. ](https://pubmed.ncbi.nlm.nih.gov/36321557/) Crider K, Williams J, Qi YP, Gutman J, Yeung L, Mai C, Finkelstain J, Mehta S, Pons-Duran C, Menéndez C, Moraleda C, Rogers L, Daniels K, Green P.Crider K, et al.Cochrane Database Syst Rev. 2022 Feb 1;2(2022):CD014217. doi: 10.1002/14651858.CD014217.Cochrane Database Syst Rev. 2022.Update in: [Cochrane Database Syst Rev. 2026 Feb 18;2:CD014217. doi: 10.1002/14651858.CD014217.pub2.](https://pubmed.ncbi.nlm.nih.gov/41705996/)PMID: 36321557Free PMC article.Updated. * [ Calcific uraemic arteriolopathy (calciphylaxis): data from a large nationwide registry. ](https://pubmed.ncbi.nlm.nih.gov/26908770/) Brandenburg VM, Kramann R, Rothe H, Kaesler N, Korbiel J, Specht P, Schmitz S, Krüger T, Floege J, Ketteler M.Brandenburg VM, et al.Nephrol Dial Transplant. 2017 Jan 1;32(1):126-132. doi: 10.1093/ndt/gfv438.Nephrol Dial Transplant. 2017.PMID: 26908770 [ See all similar articles ](https://pubmed.ncbi.nlm.nih.gov/?linkname=pubmed_pubmed&from_uid=42572798) ## Publication types * Systematic Review Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Systematic+Review%22%5Bpt%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Systematic+Review) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42572798/) * Review Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Review%22%5Bpt%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Review) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42572798/) ## MeSH terms * Calciphylaxis* / etiology Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Calciphylaxis%2Fetiology%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Calciphylaxis) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42572798/) * Calciphylaxis* / pathology Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Calciphylaxis%2Fpathology%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Calciphylaxis) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42572798/) * Female Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Female%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Female) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42572798/) * Humans Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Humans%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Humans) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42572798/) * Matrix Gla Protein Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Matrix+Gla+Protein%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Matrix+Gla+Protein) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42572798/) * Renal Dialysis Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Renal+Dialysis%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Renal+Di
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