Sodium Thiosulfate as First-Line Treatment for Calciphylaxis

Calciphylaxis is a rare but devastating condition that has continued to challenge the medical community since its early descriptions in the scientific literature many decades ago. It is predominantly seen in chronic kidney failure patients treated with dialysis (uremic calciphylaxis) but is also described in patients with earlier stages of chronic kidney disease and with normal renal function. In this In Practice feature, we review the available medical literature regarding risk factors, diagnosis, and treatment of both uremic and non-uremic calciphylaxis. High quality evidence for the evaluation and management of calciphylaxis is lacking at this time due to its rare incidence, poorly understood pathogenesis, and the relative paucity of collaborative research efforts. We hereby provide a summary of recommendations developed by the Massachusetts General Hospital's Multi-disciplinary Calciphylaxis Team for calciphylaxis patients.

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“…96-98 In all cases of calciphylaxis, excessive suppression of parathyroid hormone especially below 100 ng/mL should be avoided. 99 …”

Section: Treatmentmentioning

confidence: 99%

Calciphylaxis: Risk Factors, Diagnosis, and Treatment

Nigwekar

Kroshinsky

Nazarian

et al. 2015

American Journal of Kidney Diseases

357

505

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“…Over a dozen reports of successful use of STS in CUA followed. 36,[62][63][64][65][66][67][68][69][70] Only one report documented failure, but publication bias in favor of positsive results may be a factor. 71 In our patient, we also observed rapid improvement in pain and eventual wound healing, but we were not able to demonstrate decreased radiotracer activity on a technetium 99 bone scan performed 25 weeks after commencement of STS infusions.…”

Section: Discussionmentioning

confidence: 99%

Calcific Uremic Arteriolopathy (Calciphylaxis): Successful Treatment with Sodium Thiosulfate in Spite of Elevated Serum Phosphate

et al. 2009

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“…Ackermann et al 41 describe a patient with calciphylaxis, low intact PTH, hypercalcemia, and hyperphosphatemia in whom cinacalcet therapy yielded further decrease in PTH levels and clinical deterioration in the setting of worsening adynamic bone syndrome. 41 In addition, Khalpey et al 81 describe a patient with end-stage renal disease and secondary hyperparathyroidism in whom cinacalcet reduced PTH levels and normalized serum calcium levels, but failed to prevent calciphylaxis.…”

Section: Cinacalcetmentioning

confidence: 99%