Symptomatic management of calciphylaxis: a case series and review of the literature

Calciphylaxis, or calcific uremic arteriopathy, is a rare complication of end-stage renal impairment. It is characterized by the development of small vessel vasculopathy with subcutaneous necrosis and ulceration. Intense pain and cutaneous hyperesthesia are prominent features. Mortality rates are high, and the resulting morbidity is significant. While symptomatic management is the mainstay of treatment, it can be challenging. We describe the symptomatic management of a series of three patients with calciphylaxis. Particular emphasis is placed on the use of multimodal analgesia with high-dose opioids, ketamine, and benzodiazepines and on the use of preemptive analgesia.