Sodium Thiosulfate: Calciphylaxis

Generali, Joyce A.; Cada, Dennis J.

doi:10.1310/hpj5011-975

Cited by 19 publications

(22 citation statements)

References 9 publications

(23 reference statements)

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“…However, it has also been shown to be effective for calcium-mediated disorders. Although the mechanism underlying the effect of STS on the treatment of calciumrelated disorders is not completely understood, the drug is thought to have cation-chelating and antioxidant properties with vasodilatory properties, promoting the solubility and mobilization of calcium crystals from soft tissue calcifications 3,6) .…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Sodium Thiosulfate in Japanese Patients with Calciphylaxis

Nishiyama

Ueno

Nishiguchi

et al. 2021

International Journal of Surgical Wound Care

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Calciphylaxis is a rare disease histopathologically characterized by calcification of the medial layer of small cutaneous vessels, resulting in painful and intractable skin ulcerations in the legs. The disease is potentially lifethreatening, with more than 50% of patients dying within 1 year of diagnosis 1). Secondary infections and organ failure are also possible complications. Patients with end-stage renal disease are most susceptible to calciphylaxis; however, calciphylaxis may also affect patients with hypoparathyroidism requiring calcium salts or vitamin D, those with obesity, and those using warfarin. Ever since Cicone et al. 2) reported the successful treatment of calciphylaxis with intravenous sodium thiosulfate (STS), STS therapy has been commonly used as the first-line treatment for this disease, showing beneficial effects in most patients 3). However, systemic STS may have various side effects, such as nausea, vomiting, hypocalcemia, metabolic acidosis, and QTinterval prolongation. According to several recent reports, intralesional STS may prevent systemic side effects, but it may cause pain during injection. Although the use of STS has been described in case reports, case series, and in a single retrospective review, the effects and side effects of STS on calciphylaxis have not been confirmed by blinded randomized clinical studies. Therefore, a standardized treatment protocol for STS has not been

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Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Sodium Thiosulfate in Japanese Patients with Calciphylaxis

Nishiyama

Ueno

Nishiguchi

et al. 2021

International Journal of Surgical Wound Care

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“…Sodium thiosulfate and parathyroidectomy help regulate the calcium-phosphorus product and have improved pain along with the healing of lesions [1]. Sodium thiosulfate works by chelating calcium to produce calcium thiosulfate that is studied to be more soluble and thus more easily cleared [5]. Surgical debridement has not been shown to improve any outcomes, and penectomy has severe psychological tolls on patients [6].…”

Section: Discussionmentioning

confidence: 99%

Hyperbaric Oxygen Therapy Improving Penile Calciphylaxis

Lipinski¹,

Sahu²

2020

Cureus

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Calciphylaxis is a rare and poorly understood disease that almost exclusively occurs in endstage renal disease (ESRD). It is characterized by the calcification of medium and small dermal arterioles with resultant gangrenous necrosis. Patients develop exquisitely painful skin ulceration and necrosis, typically in the lower extremities. Treatments are severely limited, and mortality is high, as few treatment options provide a survival benefit. Improvement in a few calciphylaxis cases affecting the extremities or abdomen have been reported using hyperbaric oxygen therapy (HBOT), however, very few have had a favorable response when it affected penile tissue. We present a case of a patient with ESRD on hemodialysis and subtotal parathyroidectomy who had biopsy-proven penile calciphylaxis with refractory pain who ultimately underwent successful HBOT.

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“…The aim of wound care is to control exudate, remove necrotic devitalized tissue, prevent infection, and improve wound healing. Surgical debridement has been used by some physicians (14,17), whereas other researchers are more in favor of a con-servative wound approach (19). Some alternative treatments for calciphylaxis have been described, such as therapy with bisphosphonates (18), low-dose tissue plasminogen activator infusions, LDL-apheresis, vitamin K, hyperbaric oxygen, kidney transplantation, and STS (8).…”

Section: Discussionmentioning

confidence: 99%

“…There is no consensus on the duration of treatment with intravenous STS. According to the literature, the therapy has reportedly been applied from 2 to 8 months (17,24). The majority (80%) of patients have been treated with systemic STS for less than 3 months (14).…”

Section: Discussionmentioning

confidence: 99%

Successful treatment of extensive uremic calciphylaxis with intravenous sodium thiosulfate and its potential in treating various diseases of pathologic calcification

Burja

Jovic²,

Ekart

et al. 2019

Acta Dermatovenerologica Alpina Pannonica Et Adriatica

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A 72-year-old female patient presented with an end-stage renal disease on on-line hemodiafiltration and warfarin therapy with advanced ulcerated calciphylaxis on the lower extremities, complicated by two episodes of cellulitis. She was successfully treated for 8 months with intravenous sodium thiosulfate in combination with modification of medication and dialysis treatment, careful wound care, and other supportive measures. Calciphylaxis is an uncommon life-threatening systemic disease, mostly occurring in patients with chronic kidney disease and other risk factors. Vascular calcifications and inflammation lead to thrombotic occlusions of the cutaneous and subcutaneous arterioles, which provoke livedoid painful plaques with possible progression to necrotic ulcers. Conventional treatment is supportive. In recent decades, off-label treatment with sodium thiosulfate, a potent calcium chelator, antioxidant, and vasodilator, has been increasingly reported to be highly efficient in calciphylaxis, leading to significantly lower mortality rates. Knowledge of advancement in the treatment of calciphylaxis, which was previously a highly fatal disease, is important for physicians and other professionals from various medical fields.

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Sodium Thiosulfate: Calciphylaxis

Cited by 19 publications

References 9 publications

Efficacy and Safety of Sodium Thiosulfate in Japanese Patients with Calciphylaxis

Efficacy and Safety of Sodium Thiosulfate in Japanese Patients with Calciphylaxis

Hyperbaric Oxygen Therapy Improving Penile Calciphylaxis

Successful treatment of extensive uremic calciphylaxis with intravenous sodium thiosulfate and its potential in treating various diseases of pathologic calcification

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