title: Sodium thiosulfate therapy for calcific uremic arteriolopathy.
abstract: 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.
  
  
  METHODS
  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.
authors.affiliation: Renal Division, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. sagarnigs@gmail.com
authors.forename: Sagar U
authors.initials: SU
authors.lastname: Nigwekar
authors.forename: Steven M
authors.initials: SM
authors.lastname: Brunelli
authors.forename: Debra
authors.initials: D
authors.lastname: Meade
authors.forename: Weiling
authors.initials: W
authors.lastname: Wang
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Hymes
authors.forename: Eduardo
authors.initials: E
authors.lastname: Lacson
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D000368:Aged; D002115:Calciphylaxis / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012074:Remission Induction; D013885:Thiosulfates / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D013885:Thiosulfates; C017717:sodium thiosulfate