Use of the optimized sodium thiosulfate regimen for the treatment of calciphylaxis in Chinese patients

Ren Fail. 2022 Dec;44(1):914-922. doi: 10.1080/0886022X.2022.2081179.

Abstract

Background: Sodium thiosulfate (STS) can be used to treat patients diagnosed with calciphylaxis, which is a rare life-threatening syndrome. However, our patients treated with the recommended STS regimen presented with serious adverse events, resulting in treatment withdrawal. Then an optimized STS regimen was used to increase the tolerance of patients to STS and improve treatment continuation. The curative effect of the new regimen is not yet definite. Therefore, this study aimed to evaluate the response to the use of the optimized STS regimen for the treatment of calciphylaxis in Chinese patients during the first three courses of treatment.

Methods: Demographic, clinical, and laboratory data were retrospectively collected on 31 calciphylaxis patients with chronic kidney disease (CKD) or end-stage kidney disease (ESKD) treated with the optimized STS regimen. The primary outcome was a clinical improvement. The secondary outcomes included survival rate and adverse events.

Results: Twenty-five patients (over 80%) achieved clinical improvement considering improvement or nonspecific changes of skin lesions (80.65%) and pain relief (100%). Furthermore, 54.84% of patients did not experience any adverse events and none died from complications. During a median follow-up of 9 months (interquartile range 4‒19), 27 patients (87.10%) survived; additionally, 13 patients (41.94%) survived after a one-year follow-up period.

Conclusion: The optimized STS regimen is relatively safe, associated with satisfactory outcomes, and well tolerated by patients for short to medium treatment duration. Hence, it is a promising approach for the treatment of patients diagnosed with calciphylaxis.

Keywords: Sodium thiosulfate; calciphylaxis; clinical improvement; optimized STS regimen.

MeSH terms

  • Calciphylaxis* / drug therapy
  • Calciphylaxis* / etiology
  • Chelating Agents / adverse effects
  • China
  • Humans
  • Retrospective Studies
  • Thiosulfates

Substances

  • Chelating Agents
  • Thiosulfates
  • sodium thiosulfate

Grants and funding

This work was supported by the National Natural Science Foundation of China [grant numbers 81570612 and 81870497]; and Jiangsu Province Key Research and Development Program-social Development [grant number BE2021737].