Therapeutic effect of intravenous sodium thiosulfate for uremic pruritus in hemodialysis patients

Abstract

Objectives: This study aimed to compare the efficacy of intravenous sodium thiosulfate (IV STS) with that of loratadine in the treatment of uremic pruritus in hemodialysis (HD) patients. Methods: This retrospective study included 44 HD patients with pruritus aged over 18 years between June 2018 and January 2020 at the Aerospace Center Hospital of China. Twenty-four HD patients received 3.2 g IV STS treatment three times per week at the end of each HD session for 8 weeks. Twenty HD patients received loratadine (10 mg/day) for 8 weeks. Pruritus intensity was measured using a visual analog scale (VAS) and the detailed pruritus score (DPS) at three time points. The safety of STS was evaluated according to adverse event symptoms and biological variable changes. Results: There was no significant difference between the STS and loratadine groups in age, sex, characteristics of pruritus, or other clinical variables before treatment. After 8 weeks of treatment, the VAS score (7.07 ± 2.56 and 2.67 ± 2.01) and DPS (30.72 ± 4.81 and 8.04 ± 2.86) decreased significantly in the STS group (p < 0.05). The mean decrease in VAS score (6.89 ± 1.98 and 6.34 ± 2.35) and DPS (28.90 ± 3.24 and 26.92 ± 2.41) in the loratadine group was not statistically significant (p > 0.05). There were no morbidities or mortalities associated with the use of either drug. All biological variables remained stable after therapy. Conclusions: STS can improve uremic pruritus in HD patients. However, literature on the subject remains lacking. Close monitoring for adverse effects is advised.

Chronic Kidney Disease-Associated Itch (CKD-aI) in Children—A Narrative Review

“…Therefore, they may serve as active comparators to other investigated drugs. As an example, cetirizine failed to diminish CKD-aI in two studies, in contrast to naltrexone [ 319 ] and sodium thiosulfate [ 320 ].…”

Clinical Efficacy and Safety of Sodium Thiosulfate in the Treatment of Uremic Pruritus: A Meta-Analysis of Randomized Controlled Trials

“…We retrieved the full texts of the remaining 16 articles. After assessing for eligibility, we excluded 12 articles because five were review articles [17][18][19][20][21], one was non-RCT [22], two were not focused on UP [23,24], two were conducted on patients undergoing different treatment interventions [25,26], one was a conference abstract [27], and one was a retrospective study [16]. Finally, four RCTs fulfilled the selection criteria and were included in the meta-analysis [28][29][30][31].…”

“…The above treatments of UP caused either potential ADRs or uncertain therapeutic effects [4,5,34,35]. One retrospective study compared the efficacy of intravenous STS administration versus oral 10 mg loratadine daily for 8 weeks in 44 HD patients, and the VAS and detailed pruritus scores in the STS group significantly decreased [16]. The antioxidant or vasodilatory properties related to relieving pruritus in STS remain unclear [16].…”

“…STS is indicated for the treatment of acute cyanide poisoning [10]; however, its use for off-label indication has also been reported, such as for calcific uremic arteriolopathy or calciphylaxis, coronary artery calcification [10][11][12][13][14], and cisplatin-induced hearing loss [9,15]. A recent retrospective study proposed the potential therapeutic effect of STS in patients with UP [16]. The possible mechanism of STS in treating UP may result from boosting the production of nitric oxide, which caused vasodilation and reduced local inflammation and pruritogen [3,16].…”

“…A recent retrospective study proposed the potential therapeutic effect of STS in patients with UP [16]. The possible mechanism of STS in treating UP may result from boosting the production of nitric oxide, which caused vasodilation and reduced local inflammation and pruritogen [3,16].…”