Table 3.

Hierarchical diagnosis of calciphylaxis in dialysis patients.

Hierarchical diagnosis	Basis
Suspected diagnosis	a: There are 2 major factors, or 1 major factor and 3 minor factors. b: There are early suspicious skin changes, such as diffuse rash, purpura, subcutaneous induration, painful papules, cellulitis-like erythema and so on. c: Exclude other diseases that need to be identified
Clinical diagnosis	a: At least 1 risk factor is present. b: There are typical skin lesions, including livedo reticularis, painful purpura, painful or hemorrhagic violet plaques and indurations, necrotic ulcers and black eschar. c: Exclude other diseases that need to be identified
Confirmed diagnosis	a: Skin biopsy results are positive, showing calcification of subcutaneous microvessels, intimal fibrosis with microthrombosis, extravascular calcium deposition, and ischemic necrosis of epidermis, dermis and subcutaneous tissues. b: Presence of skin lesions: typical lesions or early suspicious changes c: Exclude other diseases that need to be identified
Risk factors: Major factors include dialysis over 5 years, long-term use of warfarin, use of high-dose calcium-phosphate binders exceeding 6 months, active vitamin D dose greater than 0.5 μg/day, plasma protein C or protein S deficiency, vitamin K deficiency, and iPTH above 1000 pg/mL. And minor factors include dialysis less than 5 years, obesity, diabetes, hypoalbuminemia, long-term use of immunosuppressants and glucocorticoids, hypercalcemia, hyperphosphatemia, hyperalkaline phosphatasemia, iPTH below 300 pg/mL, subcutaneous injection of insulin or heparin, and iron overload. Diseases that need to be identified: Including diabetic ulcer, atherosclerotic vascular disease, thromboangiitis obliterans, cellulitis, traumatic ulcer, dystrophic calcification, cholesterol embolism syndrome, vasculitis, pyoderma gangrenosum, stasis ulcer, neuropathic ulcer, warfarin-induced skin necrosis, nephrogenic systemic fibrosis and cryofibrinogenemia.