Clinical question: Does IV sodium thiosulphate improve skin lesions and survival in patients with chronic kidney disease (CKD) experiencing calciphylaxis?
Background: Calciphylaxis, also called calcific uremic arteriolopathy, is a painful skin condition caused by the calcification of microvessels in the skin. It is associated with risk factors such as end-stage renal disease, abnormal calcium and phosphate homeostasis, vitamin K deficiency, obesity, diabetes, rapid weight loss, and being female. Early detection and prompt treatment are essential for managing this condition’s symptoms. Sodium thiosulfate (STS) has been used as an off-label medication to treat calciphylaxis, providing relief from pain and promoting wound healing by reducing calcifications. While there are reports of the benefits of STS in treating calciphylaxis, no clinical trials have been conducted.
Study design: Systematic review and meta-analysis of retrospective cohort studies
Synopsis: The meta-analysis included 19 retrospective cohort studies published before August 31, 2021, which included 422 patients with CKD (estimated glomerular filtration rate <60 mL/min/1.73m2 for at least three months) who experienced calciphylaxis. These studies were selected from the 5,601 publications retrieved from targeted databases. The majority of patients were dialysis-dependent (347 patients, 82%), and 23 patients specifically used peritoneal dialysis (PD). More than half of the patients received intravenous STS (233 patients, 55.2%). The Bayes model was used to quantify skin lesion improvement and survival, while the log risk ratio or log hazard ratio was used to analyze categorical data. The analysis did not show any significant difference in skin lesion improvement and survival benefits between small studies and large studies.
Bottom line: In the largest meta-analysis of STS studies regarding calciphylaxis management to date, the use of STS treatment does not result in a decrease in skin lesion progression or mortality. Nonetheless, it is essential to recognize the limitations of comparing retrospective studies, and the impact of STS on pain intensity remains uncertain. Consequently, it may still be justifiable to employ STS in the treatment of calciphylaxis, given the severe morbidity and mortality linked to the condition.
Citation: Wen W, Portales-Castillo I, et al. Intravenous sodium thiosulphate for calciphylaxis of chronic kidney disease: a systematic review and meta-analysis. JAMA Netw Open. 2023;6(4):e2310068. doi:10.1001/jamanetworkopen.2023.10068
Dr. Nohay
Dr. Nohay is a nurse practitioner at Stanford Health Care in Palo Alto, Calif., specializing in managing dialysis patients.