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Comment & Response
August 2018

Strengthening the Case for the Role of Thrombophilia in Calciphylaxis

Author Affiliations
  • 1Cambridge Health Alliance, Cambridge, Massachusetts
  • 2Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
JAMA Dermatol. 2018;154(8):970-971. doi:10.1001/jamadermatol.2018.1534

In Reply We thank Hickson and colleagues for their interest in our Original Investigation titled “Association Between Hypercoagulable Conditions and Calciphylaxis in Patients With Renal Disease: A Case-Control Study”1 on the role of hypercoagulable conditions in the development of calciphylaxis in patients with renal disease.

To further clarify the methods used in our study, case patients were initially identified based on an algorithm of administrative codes (International Classification of Diseases, Ninth Revision code 275.49, skin biopsy procedure codes, and billing codes for renal disease) that have been previously validated.2 Of the 130 patients initially identified, 92 patients were excluded who had an alternate diagnosis based on chart review. Ultimately, 38 patients remained who had a clinical diagnosis of calciphylaxis that was determined after in-person evaluation by a dermatologist and nephrologist specializing in calciphylaxis using clinical, laboratory, imaging, and physical examination findings.3 Diagnosis was additionally confirmed by histopathologic findings in 33 patients (87%) or positive bone scan results in 2 patients (5%).

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