Would you recommend transition to hemodialysis for a patient with calciphylaxis, hyperphosphatemia, and ESKD on peritoneal dialysis?

Changing from PD to HD is a tough decision but I would do it for calcemic uremic arteriopathy CUA (calciphylaxis) for two reasons, increase clearance and guarantee IV delivery of sodium thiosulfate (STS). Peritoneal STS has been described

Mataic & Bastani, PMID 16771254

But I think CUA is life-threate...

I do. I would recommend frequent hemodialysis as it would give the best phosphorus clearance. Intensive PD would be a less ideal option but a consideration in conversation with the patient.

Sodium thiosulfate (STS) protocols for peritoneal dialysis (PD) are available, but there are limited reports and patient experience with it. Calciphylaxis is so devastating, and we know so little about treatment, that we tend to throw the kitchen sink at it. Stop warfarin, get off calcium-based bind...

HD has better outcomes in calciphylaxis with the help of parathyroidectomy, non calcium binders, sodium thiosulphate given IV, and aggressive clearances. However, mortality will still remain high due to cardiovascular calcification.