Concurrent elevation of calcium and phosphate is crucial for the development of calciphylaxis. Multiplication of serum calcium and phosphate levels (in mg/dL) with the total equal to or greater than 56 has been associated with an increased risk. In chronic renal failure, serum phosphate is generally elevated secondary to impaired excretion. Calcium levels initially fall because of decreased intestinal absorption but subsequently increase as a result of secondary hyperparathyroidism. This leads to medial calcification and intimal hyperplasia of subcutaneous arterioles. Since not all patients at risk develop calciphylaxis, presence of other factors such as local trauma and hypercoagulable states (e.g., protein C and S deficiencies) have been suggested. Other conditions that are reported to be associated with calciphylaxis include diabetes mellitus, obesity, corticosteroid use, and anticoagulation with warfarin.