Calcific uremic arteriolopathy should be treated conservatively.

Calcific uremic arteriolopathy (CUA) is a small vessel vasculopathy affecting mainly stage IV and V renal failure patients. It is characterized typically by non-healing, painful skin ulcerations and carries a poor prognosis. Little is known about the pathogenesis, but abnormal mechanisms of vascular calcification have been postulated to contribute. Available therapies target promotion of wound healing and lowering of elevated parathyroid hormone levels and the calcium-phosphate product. There are no prospective or randomized controlled trials to guide choice of therapeutic agents, yet available therapies may subject patients to adverse side effects, and/or increase program expenditures. Therefore, we favor a graded approach to treatment of CUA, commencing conservatively with the least harmful and most cost-efficient measures available.