Sodium thiosulfate delays the progression of coronary artery calcification in haemodialysis patients.
BACKGROUND
Coronary artery calcification (CAC) is prevalent among haemodialysis patients and predicts cardiovascular mortality. In addition to modifying traditional cardiovascular risk factors, therapy aimed at lowering serum phosphate and calcium-phosphate product has been advocated. Sodium thiosulfate, through its chelating property, removes calcium from precipitated minerals decreasing calcification burden in calcific uraemic arteriolopathy and soft tissue calcification. The effect of sodium thiosulfate on CAC in haemodialysis patients has never been studied.


METHODS
Eighty-seven stable chronic haemodialysis patients underwent multi-row spiral computed tomography and bone mineral density (BMD) measurement. Patients with a CAC score >or=300 were included to receive intravenous sodium thiosulfate infusion twice weekly post-haemodialysis for 4 months. CAC and BMD were re-evaluated at the end of the treatment course.


RESULTS
Progression of CAC occurred in 25% and 63% of the patients in the treatment and control group, respectively (P = 0.03). CAC score was unchanged in the treatment group but increased significantly in the control group. BMD of the total hip declined significantly in the treatment group. In multivariate analysis adjusted for factors that influenced CAC progression, therapy with sodium thiosulfate was an independent protective factor (odds ratio = 0.05, P = 0.04). Major side effects were persistent anorexia and metabolic acidosis.


CONCLUSIONS
The effect of sodium thiosulfate in delaying the progression of CAC is encouraging and will require a larger study. Determination of the safe therapeutic window is necessary in order to avoid bone demineralization.
Adirekkiat
Surawat
S
Division of Nephrology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Sumethkul
Vasant
V
Ingsathit
Atiporn
A
Domrongkitchaiporn
Somnuek
S
Phakdeekitcharoen
Bunyong
B
Kantachuvesiri
Surasak
S
Kitiyakara
Chagriya
C
Klyprayong
Pinkaew
P
Disthabanchong
Sinee
S
D000368:Aged; D015519:Bone Density / Q000187:drug effects; D002114:Calcinosis / Q000188:drug therapy* / Q000378:metabolism; D002614:Chelating Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000378:metabolism; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D013885:Thiosulfates / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
D002614:Chelating Agents; D013885:Thiosulfates; C017717:sodium thiosulfate