Anwar Elshikh: Calciphylaxis and Skin Issues in Renal Failure Patients
Anwar Elshikh, Wound Care Nurse and Intensive Care Nurse at Saudi German Hospital, shared a post on LinkedIn:
“She was on dialysis 3 times a week.
The wound on her back kept getting worse — not better.
Every dressing change, more necrosis. More pain. More confusion about what we were dealing with.
Then the labs came back. The skin findings clicked. And the diagnosis changed everything.
Calciphylaxis.
A rare but devastating condition where calcium deposits block small blood vessels in the skin — leading to:
- Excruciating painful nodules
- Livedo reticularis (retiform purpura)
- Deep necrotic ulcers with black eschar
- Rapid progression to sepsis
And the cruel irony?
The more aggressively you debride — the worse it gets.
This is not a wound you treat like a pressure injury.
The approach is completely different:
- Stop warfarin if the patient is on it
- Sodium Thiosulfate IV — 3x/week with every dialysis session
- Control mineral metabolism — lower phosphate, manage PTH, avoid high Ca and P product
- Gentle wound care only — infection control with pain management
- Optimize nutrition — protein, albumin
Mortality can reach 60–80% within one year. But early recognition changes outcomes.
As wound care clinicians — we are often the first ones to notice. The first ones to ask the right questions.
The first ones to say:
‘This doesn’t look like a typical wound.’
Trust that instinct. It saves lives.”
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