Hyperbaric oxygen treatment in addition to conventional multidisciplinary care in patients with calciphylaxis

Background: Calciphylaxis is a rare and serious complication in patients with kidney disease. It has few treatment options and poor prognosis. Hyperbaric oxygen therapy (HBOT) may improve wound healing and was added to our conventional care in 2012. Materials and methods: Data from all calciphylaxis patients treated from 2012 to 2022 were retrieved from hospital records. HBOT was added to our multidisciplinary care of calciphylaxis, which included sodium-thiosulphate, dialysis if indicated, medical optimization of calcium-phosphate homeostasis, substitution of vitamin K2, withdrawal of warfarin, iron and vitamin D, and minimization of systemic steroids. In addition, weight- and nutritional status was optimized, and wound care was thoroughly performed. Results: 25 patients received a total number of 1,493 HBOT treatments in addition to conventional care in the study period. Median HBOT per patient was 45 (range 1 - 267). One year after diagnosis, 18 out of 25 patients were alive. 15 out of the 18 patients alive 1 year after diagnosis had completely resolved wound lesions. Seven patients died within the first year after diagnosis due to cardiovascular disease (n = 3), infection (n = 3), and cancer (n = 1). Conclusion: Our results suggest that HBOT is welltolerated and may be associated with beneficial effects on survival and wound-healing when combined with multidisciplinary care.