title: Use of sodium thiosulphate in a multi-interventional setting for the treatment of calciphylaxis in dialysis patients.
abstract: BACKGROUND
  Calciphylaxis is a life-threatening complication in patients with end-stage renal disease (ESRD). No established therapy exists so far. The aim of the present study was to determine the therapeutic response to a multi-interventional treatment regimen with consistent use of sodium thiosulphate (STS) in an Austrian cohort of calciphylaxis patients.
  
  
  METHODS
  We retrospectively collected demographic, clinical and laboratory data on 27 calciphylaxis patients treated with STS at seven Austrian dialysis centres between June 2004 and November 2010.
  
  
  RESULTS
  Twenty-seven dialysis patients (68 ± 12 years) were treated with STS for a median (25th, 75th percentile) of 96 (54, 133) days. Seven patients (26%) suffered from proximal-type, and 20 patients (74%) from distal-type calciphylaxis. Fourteen patients (52%) showed a complete remission, five patients (19%) a partial remission and eight patients (30%) progression that resulted in amputation in four patients. During a median follow-up of 101 (79, 273) days, 14 patients died (52%). Non-survivors were older (P = 0.04), showed higher CRP values (P = 0.04), presented more frequently with proximal-type calciphylaxis (P = 0.03), had a higher disease severity score at diagnosis (P = 0.01), were treated more often with antibiotics (P = 0.01) and cinacalcet (P = 0.03) and had a lower remission rate during treatment (P = 0.004) than did survivors. The use of antibiotics and cinacalcet, disease severity at diagnosis and remission rates were found to be significant survival predictors in logistic regression analysis.
  
  
  CONCLUSIONS
  Calciphylaxis remains a serious complication with high mortality. Early and consistent therapy including STS may help to improve the disease outcome.
authors.affiliation: Department of Nephrology and Dialysis, Academic Teaching Hospital Feldkirch, Feldkirch, Austria. emanuel.zitt@lkhf.at
authors.forename: Emanuel
authors.initials: E
authors.lastname: Zitt
authors.forename: Matthias
authors.initials: M
authors.lastname: König
authors.forename: Andreas
authors.initials: A
authors.lastname: Vychytil
authors.forename: Martin
authors.initials: M
authors.lastname: Auinger
authors.forename: Manfred
authors.initials: M
authors.lastname: Wallner
authors.forename: Gernot
authors.initials: G
authors.lastname: Lingenhel
authors.forename: Gernot
authors.initials: G
authors.lastname: Schilcher
authors.forename: Michael
authors.initials: M
authors.lastname: Rudnicki
authors.forename: Hermann
authors.initials: H
authors.lastname: Salmhofer
authors.forename: Karl
authors.initials: K
authors.lastname: Lhotta
mesh_terms: D000368:Aged; D002115:Calciphylaxis / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D002614:Chelating Agents / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D006435:Renal Dialysis / Q000401:mortality*; D012189:Retrospective Studies; D015996:Survival Rate; D013885:Thiosulfates / Q000627:therapeutic use*
chemical_list: D002614:Chelating Agents; D013885:Thiosulfates; C017717:sodium thiosulfate
keywords: calcific uraemic arteriolopathy; calciphylaxis; dialysis; end-stage renal disease; sodium thiosulphate