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: Emanuel Zitt, Matthias König, Andreas Vychytil, Martin Auinger, Manfred Wallner, Gernot Lingenhel, Gernot Schilcher, Michael Rudnicki, Hermann Salmhofer, Karl Lhotta
• Journal: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association (Nephrol Dial Transplant) Vol. 28 Issue 5 Pg. 1232-40 (May 2013) ISSN: 1460-2385 [Electronic] England
• PMID: 23291368 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Chemical References

• Chelating Agents
• Thiosulfates
• sodium thiosulfate

Topics

• Aged
• Calciphylaxis (drug therapy, etiology, mortality)
• Chelating Agents (therapeutic use)
• Female
• Follow-Up Studies
• Humans
• Kidney Failure, Chronic (complications)
• Male
• Middle Aged
• Prognosis
• Renal Dialysis (mortality)
• Retrospective Studies
• Survival Rate
• Thiosulfates (therapeutic use)