Successful treatment of calciphylaxis with intravenous sodium thiosulfate

Cicone, Jeffrey; Petronis, John B; Embert, Carmen D; Spector, David A.

doi:10.1053/j.ajkd.2004.03.018

Cited by 252 publications

(224 citation statements)

References 21 publications

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“…These and other investigators subsequently described improvement in soft-tissue calcifications with STS in small ESRD cohorts (27,28). Given the successful use of STS in these settings, Cicone et al attempted intravenous STS for CUA and published the first case report outlining STS as a potential treatment for this highly fatal condition (15). Although many case reports and case series have been published on this topic since then, systematic evaluation of STS is lacking and prior attempts at such evaluation have been limited by small sample sizes, with the largest series having 14 patients (29,30).…”

Section: Discussionmentioning

confidence: 99%

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Sodium Thiosulfate Therapy for Calcific Uremic Arteriolopathy

Nigwekar

Brunelli

Meade

et al. 2013

Clinical Journal of the American Society of Nephrology

185

136

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SummaryBackground and objective Calcific uremic arteriolopathy (CUA) is an often fatal condition with no effective treatment. Multiple case reports and case series have described intravenous sodium thiosulfate (STS) administration in CUA, but no studies have systematically evaluated this treatment.Design, setting, participants, & measurements This study included 172 patients undergoing maintenance hemodialysis who had CUA and were treated with STS between August 2006 and June 2009 at Fresenius Medical Care North America. Of these, 85% completed STS therapy. Clinical, laboratory, and mortality data were abstracted from clinical information systems. Responses to survey questionnaires sent to treating physicians regarding patient-level outcomes were available for 53 patients. Effect on CUA lesions and mortality were summarized as CUA outcomes. Relevant laboratory measures, weight (using pairwise comparisons of values before, during, and after STS), and adverse events were summarized as safety parameters.Results Mean age of the cohort was 55 years, and 74% of patients were women. Median STS dose was 25 g, and median number of doses was 38. Among surveyed patients, CUA completely resolved in 26.4%, markedly improved in 18.9%, improved in 28.3%, and did not improve in 5.7%; in the remaining patients (20.8%), the response was unknown. One-year mortality in patients treated with STS was 35%. Adverse events, laboratory abnormalities, and weight-related changes were mild. Significant reductions in serum phosphorous (P=0.02) and parathyroid hormone (P=0.01) were noted during STS treatment in patients who completed the therapy.Conclusions Although conclusive evidence regarding its efficacy is lacking, a majority of patients who received STS demonstrated clinical improvement in this study.

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Section: Discussionmentioning

confidence: 99%

“…Cicone et al first reported that administration of sodium thiosulfate (STS) may be useful in treating CUA (15). Although the exact mechanism of action is unknown (16,17), several case reports and small case series have been published on STS administration for CUA (17).…”

Section: Introductionmentioning

confidence: 99%

Sodium Thiosulfate Therapy for Calcific Uremic Arteriolopathy

Nigwekar

Brunelli

Meade

et al. 2013

Clinical Journal of the American Society of Nephrology

185

136

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“…There was no further deterioration of his condition, and the discontinuation of the medication was accompanied by recurrence of renal colic. Cicone et al (2) were the first to report the benefits of STS in one peritoneal dialysis patient with CUA. They noted significant pain relief as well as reduction in the size and the induration of the subcutaneous plaques after a total of 8 mo of treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Intravenous sodium thiosulfate (STS) has been used successfully in three individual case reports in the treatment of hemodialysis and peritoneal dialysis patients with severe CUA (Table 1) (2)(3)(4). STS is an antioxidant agent and a chelator of cations (e.g., calcium) and initially was used as an antidote for cyanide and cisplatin toxicity.…”

mentioning

confidence: 99%

Sodium Thiosulfate Treatment for Calcific Uremic Arteriolopathy in Children and Young Adults

Araya¹,

Fennell²,

Neiberger³

et al. 2006

Clinical Journal of the American Society of Nephrology

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In adult patients with ESRD, calcific uremic arteriolopathy (CUA) is an uncommon but life-threatening complication. No effective therapy exists, although anecdotal case reports highlight the use of sodium thiosulfate (STS), a calcium-chelating agent with antioxidant properties. CUA is rare in children, and STS use has not been reported. The objective of this study was to determine the influence of STS treatment on three patients with CUA in a pediatric chronic dialysis unit. The patients were between 12 and 21 yr of age; two were male; and primary diagnoses were obstructive uropathy, renal dysplasia, and calcineurin nephrotoxicity. Time from ESRD to CUA diagnosis was 1, 9, and 20 yr. Diagnosis was made by tissue biopsy and three-phase bone scan. Pain was the presenting symptom. Initial treatment included discontinuation of calcitriol and use of non-calciumbased phosphate binders and low-calcium dialysate concentration. STS dosage was 25 g/1.73 m 2 per dose intravenously after each hemodialysis session. For optimization of removal of calcium deposits, patient three received a combination of STS and continuous venovenous hemofiltration for the first 10 d. All patients demonstrated rapid pain relief. Within weeks, skin induration and joint mobility of the extremities improved. Radiographic evidence of reduction in the calcium deposits occurred within 3 mo of initiation of STS. The only complication was prolonged QT interval in one patient as a result of hypocalcemia, who was resolved by use of a higher dialysate calcium concentration. STS seems well tolerated in children and young adults with CUA and has mild adverse effects. For determination of its efficacy, optimum dosage, duration of therapy, and dialysis modality, controlled trials are needed.

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“…Calciphylaxis (or calcific uremic arteriolopathy) has been described as an uncommon but dreaded complication of renal failure characterized by nodular or plaque-like subcutaneous calcification and painful tissue necrosis often leading to ulceration and secondary infection (1)(2)(3)(4). Mortality rates range from 30% in patients with plaquelike lesions and no ulceration to greater than 80% in patients presenting with or developing ulcerations (3,5).…”

Section: Introductionmentioning

confidence: 99%

Superior vena cava syndrome complicating calcific uremic arteriolopathy in an ESRD male patient on maintenance hemodialysis following failed kidney transplantation

Onuigbo¹,

Agbasi²,

Khan³

et al. 2017

J Parathyr Dis

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We described the unusual presentation of right unilateral facial swelling in a 48-year old end-stage renal disease (ESRD) male patient on maintenance hemodialysis following a failed kidney transplant. This was subsequently confirmed to be secondary to the extrinsic compression of the superior vena cava (SVC) by a large lobulated amorphous extra-osseous right axillary mass lesion that extended into the upper right thoracic outlet. Superior vena cava venogram and balloon angioplasty led to symptomatic relief. The factors involved in the pathogenesis of calciphylaxis are discussed and the available therapeutic options for this rare albeit debilitating disease are reviewed. Keywords: Calciphylaxis, Uremic arteriolopathy, Hemodialysis, Chronic kidney disease, Calcimimetics, End-stage renal disease Please cite this paper as: Onuigbo MAC, Khan A, Nijhawan V, Jiang Z. Superior vena cava syndrome complicating calcific uremic arteriolopathy in an ESRD male patient on maintenance hemodialysis following failed kidney transplantation J Parathyr Dis. 2018;6(2):68-71.

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Successful treatment of calciphylaxis with intravenous sodium thiosulfate

Cited by 252 publications

References 21 publications

Sodium Thiosulfate Therapy for Calcific Uremic Arteriolopathy

Sodium Thiosulfate Therapy for Calcific Uremic Arteriolopathy

Sodium Thiosulfate Treatment for Calcific Uremic Arteriolopathy in Children and Young Adults

Superior vena cava syndrome complicating calcific uremic arteriolopathy in an ESRD male patient on maintenance hemodialysis following failed kidney transplantation

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