Sodium Thiosulfate and the Anion Gap in Patients Treated by Hemodialysis

Hundemer, Gregory L.; Fenves, Andrew Z.; Phillips, Kristy M.; Emmett, Michael

doi:10.1053/j.ajkd.2016.02.040

Cited by 12 publications

(4 citation statements)

References 9 publications

(12 reference statements)

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“…The results confirm that PD can be a safe method of introducing RRT in unplanned acute dialysis settings. In general they are comparable with those of other authors, presented in Table 9 (Song et al, 2000; Banli et al, 2005; Povlsen and Ivarsen, 2006; Jo et al, 2007; Lobbedez et al, 2008; Yang et al, 2011; Casaretto et al, 2012; Ghaffari, 2012; Koch et al, 2012; Masseur et al, 2014; Alkatheeri et al, 2016; Bitencourt Dias et al 2016, 2017; Jin et al, 2016; Pai et al, 2016; Wong et al, 2016; Xu et al, 2017; Wang et al, 2017; Nayak et al, 2018). However, there are many methodological differences among these studies concerning patients population, the technique of peritoneal catheter placement, or length of break-in period.…”

Section: Discussionsupporting

confidence: 91%

Urgent-Start Peritoneal Dialysis as a Bridge to Definitive Chronic Renal Replacement Therapy: Short- and Long-Term Outcomes

et al. 2019

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Background: The peritoneal dialysis (PD) urgent-start pathway, without typical 2-week break-in period, was meant for late-referral patients able and prone to join PD-first program, with its main advantages such as: keeping the vascular system intact, preserving their residual renal function and retaining life-style flexibility. We compared the short- and long-term outcomes of consecutive 35 patients after urgent- and 94 patients after the planned start of PD as the first choice.Methods: The study included all incident end-stage renal disease patients starting PD program between January 2005 and December 2015, classified into two groups: those with urgent (unplanned) and those with elective (planned) start. Urgent PD was initiated as an overnight automatic procedure (APD) with dwell volume gradually increased, and after 2–3 weeks, target PD method was established.Results: The mean time between catheter implantation and PD start was 3.5 ± 2.3 in urgent and 16.2 ± 1.7 days in planned-start groups (p < 0.00001). 51% of the patients in the urgent-start group required PD during first 48 h after catheter insertion. Mean follow-up of 17.6 ± 11.09 months (median: 19.0) was in the urgent-start group and 28.6 ± 26.6 months (median: 19.5) in the planned-start group. The early mechanical complications were observed more often in the urgent-start group (29 vs. 4%, p = 0.00005). The only significant predictors of early mechanical complications were serum albumin (p = 0.02) and time between the catheter insertion and PD start. The first year patient survival and technique survival censored for death and kidney transplantation were not significantly different between groups. In Cox proportional analysis the independent risk factors for patient survival as well as for method and patient survival appeared Charlson Comorbidity Index CCI (HR 1.4; p = 0.01 and 1.24; p = 0.02) and time from catheter implantation to PD start with HR 5.11; p = 0.03 and 4.29; p = 0.04 for <2 days, while time >14 days lost its predictive value (p = 0.07).Conclusion: Peritoneal dialysis may be a feasible and safe alternative to HD in patients who need to start dialysis urgently without established dialysis access, with an acceptable complications rates, as well as patient and technique survival.

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Section: Discussionsupporting

confidence: 91%

Urgent-Start Peritoneal Dialysis as a Bridge to Definitive Chronic Renal Replacement Therapy: Short- and Long-Term Outcomes

et al. 2019

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“…As shown in the present study, the STS infusion during the last hour of HD could yield a significant elevation in the pre-dialysis anion gap, indicating the presence of certain STS serum levels. Although the serum anion gap values in the present study (last hour of HD regimen) were slightly lower than those mentioned in previous studies (post-HD regimen) [18, 19, 34] (mean anion gap changes of 2.3 vs. 2.5–6.6, respectively), the administered STS dose was sufficient to provide a significant benefit in reducing the AS and stabilizing the CAC score. However, further pharmacokinetic studies are needed to determine the more optimal STS dose to use during the last hour of the HD regimen.…”

Section: Discussioncontrasting

confidence: 87%

Effect of Sodium Thiosulfate on Arterial Stiffness in End-Stage Renal Disease Patients Undergoing Chronic Hemodialysis (Sodium Thiosulfate-Hemodialysis Study): A Randomized Controlled Trial

Saengpanit

Chattranukulchai

Tumkosit

et al. 2018

Nephron

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Background: Arterial stiffness (AS) and vascular calcification are significantly related to a high cardiovascular mortality risk in hemodialysis (HD) patients. Intravenous sodium thiosulfate (IV STS) can prevent and delay the vascular calcification progression in uremic states; however, the STS effect on AS has not been assessed. This study aimed to evaluate the STS efficacy on vascular calcification and AS in HD patients. Methods: Fifty HD patients with abnormal AS, as measured via the cardio-ankle vascular index (CAVI ≥8), were prospectively randomized to open-label 12.5 g IV STS during the last HD hour twice weekly for 6 months (n = 24) or the usual care (control group; n = 26). Patients and treating physicians were not blinded. The CAVI, coronary artery calcification (CAC) score, hemodynamics, and biochemical parameters were measured at the baseline and at 3 and 6 months. Results: All the baseline parameters were comparable. The IV STS significantly reduced the CAVI when compared to the control group (mean CAVI difference = –0.53; 95% CI –1.00 to –0.06; p = 0.03). A significant CAVI improvement was seen in those patients without diabetes mellitus. The natural logarithm of the CAC volume score was significantly increased in the control group. The high sensitivity C-reactive protein level was slightly lowered in the IV STS group (not significant). Conclusion: The intradialytic STS treatment significantly reduced the AS, as measured by the CAVI, and stabilized the vascular calcification in the HD patients. STS may be a novel therapeutic strategy for delaying and treating the structural and functional vascular wall abnormalities in HD patients.

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“…Still, despite its longtime use in the medical and industrial domains, we understand relatively little about its pharmacodynamic effects in the body. In the literature, two types of acidosis produced by STS administration are described: one, a dose‐dependent, mild and asymptomatic acidosis present in most patients on STS therapy and another, a severe, life‐threatening acidosis out of proportion with the expected acid load of STS . Here, we discuss the known pharmacology of STS and discuss the properties of hydrogen sulfide, a metabolite of STS, that may play an additional role in both STS efficacy and side effects …”

Section: Discussionmentioning

confidence: 99%

Metabolic acidosis after sodium thiosulfate infusion and the role of hydrogen sulfide

Hunt

Ryder

2018

Clinical Case Reports

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Sodium Thiosulfate and the Anion Gap in Patients Treated by Hemodialysis

Cited by 12 publications

References 9 publications

Urgent-Start Peritoneal Dialysis as a Bridge to Definitive Chronic Renal Replacement Therapy: Short- and Long-Term Outcomes

Urgent-Start Peritoneal Dialysis as a Bridge to Definitive Chronic Renal Replacement Therapy: Short- and Long-Term Outcomes

Effect of Sodium Thiosulfate on Arterial Stiffness in End-Stage Renal Disease Patients Undergoing Chronic Hemodialysis (Sodium Thiosulfate-Hemodialysis Study): A Randomized Controlled Trial

Metabolic acidosis after sodium thiosulfate infusion and the role of hydrogen sulfide

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