Multiple Ectopic Calcifications in ESRD: Role of Inflammatory and Partial Reversibility with Intensified Peritoneal Dialysis (PD)

Introduction: Ectopic calcification is a rare and serious complication in CKD. It is commonly associated with cardiovascular morbidity and mortality. This case report highlights the occurrence of multiple ectopic calcifications in a PD patient , emphasizing the role of inflammatory cytokines in the pathogenesis. Early and appropriate intervention can facilitate partial reversibility, highlighting the intensified high-quality, goal-oriented dialysis. Case Description: A 68-year-old female patient with diabetic nephropathy had been on PD for four years. Ultrasound and CT imaging revealed hyperechoic lesions and calcifications in the subcutaneous tissue, along with vascular and kidney calcifications. Laboratory results indicated inadequate dialysis, hypocalcemia, hyperphosphatemia, and significantly elevated PTH and inflammatory cytokines, including IL-6. The biopsy of the subcutaneous nodule revealed calcification and accompanied by pronounced IL-6. Treatment included intensified APD combined with icodextrin PDS for long-term retention. After a month, the patient's ectopic calcification showed significant improvement. Discussion: IL-6 was markedly elevated in the patient. More importantly, the spatial pattern of IL-6 expression overlapped with the area of ectopic calcification. Given the history of diabetes mellitus, IL-6 could have potentially played a role as one of the mediators in the hyperinsulinemic state. In this case, APD is a viable alternative to achieve clearance and ultrafiltration goals, while also improving the patient's quality of life. Ico-based PDS offer superior biocompatibility and contain low levels of GDPs, helping to mitigate chronic peritoneal inflammation. Therefore, APD combined with icodextrin PDS could optimally alleviate ectopic deposition. Consequently, high-frequency ultrasound proved to be an essential tool for evaluating treatment effectiveness during follow-up.High-frequency ultrasound and CT imaging findings of soft tissue calcification