Sodium thiosulfate is effective in calcific uremic arteriolopathy complicating chronic hemodialysis.
BACKGROUND
Calcific uremic arteriolopathy (CUA) or calciphylaxis is a severe complication of advanced chronic kidney disease (CKD) and dialysis. Few effective treatments are available and the mortality rate is high. We report 4 cases in which sodium thiosulfate therapy was rapidly effective.


METHODS
Sodium thiosulfate therapy was given to 4 Caucasian patients (3 females and 1 male aged 49 to 91 years) with CUA. The causes of end-stage CKD were nephroangiosclerosis (n=2) and diabetic nephropathy (n=2). The lesions developed 1 to 6.5 years after the initiation of hemodialysis and involved the lower limbs in 2 patients, the fingers in 1 patient, and a breast in the remaining patient. They were responsible for pain and skin necrosis in all 4 patients. Local superinfection occurred in 3 patients. Intravenous sodium thiosulfate was given in a dosage of 12.5 to 25g after each hemodialysis session, for 12 to 24 weeks. The pain and trophic disorders resolved fully in all 4 patients. The side effects consisted of nausea and vomiting (n=2) and a moderate blood pressure decrease (n=1). No recurrences were noted during the follow-up of 5 to 17 months after treatment discontinuation.


CONCLUSIONS
The findings from this small case-series suggest that sodium thiosulfate may hold promise for the treatment of CUA.
Service de rhumatologie, pôle appareil locomoteur, centre Viggo-Petersen, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France.
Stéphanie
S
Malbos
Clinique du Landy, 93400 Saint-Ouen, France; Service des explorations fonctionnelles rénales, hôpital Necker, 75015 Paris, France.
Pablo
P
Ureña-Torres
Service de rhumatologie, pôle appareil locomoteur, centre Viggo-Petersen, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France; UFR de médecine, université Paris Diderot, Sorbonne Paris Cité, 75205 Paris, France.
Thomas
T
Bardin
Service de rhumatologie, pôle appareil locomoteur, centre Viggo-Petersen, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France; UFR de médecine, université Paris Diderot, Sorbonne Paris Cité, 75205 Paris, France; Inserm, UMR-1132, hôpital Lariboisière, 75010 Paris, France. Electronic address: hang-korng.ea@lrb.aphp.fr.
Hang-Korng
HK
Ea
D000368:Aged; D000369:Aged, 80 and over; D000975:Antioxidants / Q000008:administration & dosage*; D001160:Arterioles; D002115:Calciphylaxis / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects*; D013885:Thiosulfates / Q000008:administration & dosage*; D014511:Uremia / Q000209:etiology
D000975:Antioxidants; D013885:Thiosulfates; C017717:sodium thiosulfate
Apatite; Calcific uremic arteriolopathy; Calciphylaxis; Dialysis; Sodium thiosulfate; Vascular calcifications