Introduction: Calciphylaxis, also known as calcific uremic arteriolopathy (CUA), is a rare and potentially fatal condition primarily affecting patients with end-stage renal disease (ESRD) on hemodialysis (HD). It is characterized by calcification in small blood vessels, leading to painful skin ulcers and high mortality rates. Case Description: This is a case of a 42-year-old female with ESRD on HD who developed calciphylaxis, presenting with non-healing ulcers on her thighs. Discussion: Despite initial treatments, including wound care and pain management, her condition did not improve. A skin biopsy was inconclusive, highlighting the diagnostic challenges associated with calciphylaxis. Based on clinical judgment, warfarin and calcium-based therapies were discontinued, and the patient’s HD regimen was adjusted. Due to the persistence of symptoms, sodium thiosulfate (STS) therapy was initiated, leading to significant improvement in her ulcers after six months of treatment. Conclusions: This case highlights the importance of clinical judgment in the diagnosis and management of calciphylaxis, particularly when histopathological diagnostic methods yield inconclusive results. Clinical criteria, alongside a thorough assessment of the patient’s history and presentation, are vital for achieving a timely diagnosis in such challenging cases. The successful use of sodium thiosulfate in this patient adds to the growing body of evidence supporting its use as a potential treatment for calciphylaxis, especially in cases that do not respond to conventional therapy.

Background: Albuminuria is a key marker for the early detection of chronic kidney disease (CKD) in patients with diabetes mellitus and hypertension. Despite guideline recommendations for albuminuria testing in these high-risk populations, adherence remains suboptimal. Methods: A retrospective study was conducted at a tertiary center in Al-Ahsa, Saudi Arabia. Data were collected from the records of 516 adults with diabetes mellitus, hypertension, or both. Patients with CKD were excluded. The primary outcome was the rate of albumin-to-creatinine ratio (ACR) testing. Results: Among 516 patients (mean age 63.7 ± 7.6 years), the overall prevalence of ACR testing was 59.1%. Testing was highest in the diabetes-only subgroup (69.5%), followed by the diabetes with hypertension subgroup (66.3%), and lowest in the hypertension-only subgroup (19.3%) (p< 0.001). Testing was more likely in patients with high HbA1c, more outpatient visits, and among individuals using angiotensin receptor blockers (ARBs) and sodium-glucose cotransporter-2 (SGLT-2) inhibitors. After adjustment, hypertension-only patients were less likely to be tested (adjusted odds ratio [AOR] = 0.14; 95% CI: 0.07– 0.31), whereas the use of ARBs (AOR = 3.17; 95% CI: 1.69– 5.93) and SGLT2 inhibitors (AOR = 3.00; 95% CI: 1.31– 6.90) was independently associated with increased testing. Of those tested, 40% had albuminuria (A2 or A3). Conclusion: Albuminuria testing is substantially underutilized among high-risk patients in Saudi Arabia. Individuals with hypertension only are the least likely to undergo screening. This suggests a gap between clinical practice and guideline recommendations. These findings highlight the need for strategies to improve early CKD detection, particularly in primary care.