Calcific Uremic Arteriolopathy in Hemodialysis Patients: A Report of Two Cases and Review of the Literature

Calcific uremic arteriolopathy (CUA), or calciphylaxis, is a rare but life-threatening vascular disorder predominantly affecting patients with end-stage renal disease ongoing hemodialysis. It is characterized by systemic calcification and thrombosis of small arterioles, leading to painful skin necrosis and a high risk of morbidity and mortality. This study presents two cases of hemodialysis patients diagnosed with CUA, highlighting key clinical features, risk factors, and therapeutic challenges. Both patients presented classic predisposing factors, including calcium-phosphorus imbalance, secondary/tertiary hyperparathyroidism, and systemic inflammation. Despite early intervention with phosphate binders, wound care, and dialysis modifications, outcomes varied, reflecting the complexity of disease management. A literature review was conducted to analyze current diagnostic approaches and evolving treatment modalities, emphasizing the need for early diagnosis, multidisciplinary management, and efficient therapeutic strategies. Given the lack of standardized treatment protocols, further research is essential to improve patient outcomes and establish evidence-based guidelines for CUA management in hemodialysis patients.