Calciphylaxis in chronic kidney disease: a systematic review of pathomechanisms and risk factors for calcific uremic arteriolopathy.

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. 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.