title: Possibly enhanced Gd excretion in dialysate, but no major clinical benefit of 3-5 months of treatment with sodium thiosulfate in late stages of nephrogenic systemic fibrosis.
abstract: BACKGROUND
  Gd-related nephrogenic systemic fibrosis was successfully treated with intravenous sodium thiosulfate according to a recent case report.
  
  
  METHODS
  Four haemodialysis patients with severe Gd-related nephrogenic systemic fibrosis were treated with intravenous sodium thiosulfate for 3-5 months. Symptoms and patients' experiences were investigated. The dialysate Gd content was monitored.
  
  
  RESULTS
  We observed no major clinical improvements in any patient. In one patient, we found slightly improved joint motion. Two patients had a subjective impression of slight improvements of joint motion and skin abnormalities. The dialysate Gd content was raised by the treatment, up to fivefold.
  
  
  CONCLUSIONS
  We could not confirm that sodium thiosulfate treatment results in marked and rapid improvement in late stages of Gd-related nephrogenic systemic fibrosis. However, dialysate contents of Gd seemed to increase. It is unknown whether increased Gd excretion will lead to long-term clinical improvements in late stages of nephrogenic systemic fibrosis.
authors.affiliation: Department of nephrology, Copenhagen University Hospital Herlev, Herlev Ringvej 75, DK-2730 Herlev, Denmark. peter.marckmann@dadlnet.dk
authors.forename: Peter
authors.initials: P
authors.lastname: Marckmann
authors.forename: Arne Høj
authors.initials: AH
authors.lastname: Nielsen
authors.forename: Jens Jørgen
authors.initials: JJ
authors.lastname: Sloth
mesh_terms: D000328:Adult; D002614:Chelating Agents / Q000627:therapeutic use; D003287:Contrast Media / Q000009:adverse effects / Q000493:pharmacokinetics; D005260:Female; D005682:Gadolinium / Q000009:adverse effects* / Q000493:pharmacokinetics*; D019786:Gadolinium DTPA / Q000009:adverse effects / Q000493:pharmacokinetics; D015312:Hemodialysis Solutions / Q000032:analysis; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000009:adverse effects; D008875:Middle Aged; D054989:Nephrogenic Fibrosing Dermopathy / Q000188:drug therapy* / Q000209:etiology* / Q000378:metabolism / Q000517:prevention & control; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000175:diagnosis; D013885:Thiosulfates / Q000627:therapeutic use*; D013997:Time Factors
chemical_list: D002614:Chelating Agents; D003287:Contrast Media; D015312:Hemodialysis Solutions; D013885:Thiosulfates; C064925:gadodiamide; D005682:Gadolinium; C017717:sodium thiosulfate; D019786:Gadolinium DTPA