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| Year : 2008 | Volume
: 19
| Issue : 5 | Page : 820-821 |
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| Oral Sodium Thiosulfate Solution as a Secondary Preventive Treatment for Calciphylaxis in Dialysis Patients |
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Carlos Guido Musso1, Paula Enz2, Flavia Vidal3, Rodolfo Gelman4, Luis Di Giuseppe5, Pablo Bevione1, Leonardo Garfi5, Ricardo Galimberti2, Luis Algranati1
1 Department of Nephrology, Hospital Italiano de Buenos Aires, Argentina
2 Department of Dermatology, Hospital Italiano de Buenos Aires, Argentina
3 Department of Toxicology, Hospital Italiano de Buenos Aires, Argentina
4 Department of Endocrinology, Hospital Italiano de Buenos Aires, Argentina
5 Department of Pharmacy, Hospital Italiano de Buenos Aires, Argentina
Click here for correspondence address and email
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How to cite this article:
Musso CG, Enz P, Vidal F, Gelman R, Di Giuseppe L, Bevione P, Garfi L, Galimberti R, Algranati L. Oral Sodium Thiosulfate Solution as a Secondary Preventive Treatment for Calciphylaxis in Dialysis Patients. Saudi J Kidney Dis Transpl 2008;19:820-1 |
How to cite this URL:
Musso CG, Enz P, Vidal F, Gelman R, Di Giuseppe L, Bevione P, Garfi L, Galimberti R, Algranati L. Oral Sodium Thiosulfate Solution as a Secondary Preventive Treatment for Calciphylaxis in Dialysis Patients. Saudi J Kidney Dis Transpl [serial online] 2008 [cited 2023 Jan 30];19:820-1. Available from: https://www.sjkdt.org/text.asp?2008/19/5/820/42471 |
To the Editor,
Calciphylaxis is a severe complication in chronic dialysis patients which consists of an inflammation of the skin with edema, erhythema and pain that may evolve to extensive superficial necrosis of the skin resulting in ulceration and scar formation overlying a panniculitis. Such lesions are most often located on the abdomen, buttocks, thighs, and/or legs. Diagnosis is confirmed when calcification of the middle layer of the dermis small arteries is documented in the affected areas. [1],[2]
There are recent reports regarding the potential therapeutic benefits of intravenous sodium thiosulfate (37.5–75 grams/week) in calciphylaxis. This substance is an inorganic pentahydrated salt which is absorbed from the digestive tract. In addition, it is distributed to the whole extracellular fluid when administered intravenously, and is quickly excreted in the urine. Except for the osmotic alterations, that can cause diarrhea, sodium thiosulfate is not toxic. It has also been described as a therapeutic alternative in cyanide intoxication (intravenous), and calcium urolithiasis (oral). [3],[4],[5]
We would like to share our experience of using oral sodium thiosulfate (7.5 grams/week) as a secondary preventive treatment for calciphylaxis. Our patient was a 59 year-old woman on maintenance hemodialysis with other comorbidities including diabetes mellitus (type II), arterial hypertension, obesity, and parathyroid hormone surgery due to hyperparathyroidism. She developed severe abdominal and inguinal calciphylaxis ulcers that healed with intravenous sodium thiosulfate (37.5 grams/week) after each hemodialysis session for a period of eleven months. Even after her ulcers completely healed, due to the multiple risk factors, we decided to continue sodium thiosulfate treatment as an oral preparation of 2 M (molar) solution: 74.4 grams in free water (150 cc). Since this was a secondary preventive measure, we decided to use half of the intravenous dose: 2.6 grams/day. However, the patient developed diarrhea and the dose was reduced to 2.6 grams after each hemodialysis session (thrice a week). She received this secondary preventive treatment for a lapse of one year, during she maintained serum calcium level: 8.3 mg/dL (range: 7.3–9 mg/dL), serum phosphorus: 5.4 mg/dL (range 4–6.7 mg/dL), calcium-phosphorus product (45 mg/dL), and serum parathyroid hormone: 365 pg/dL, while she was taking calcium acetate (8 grams/day) as phosphorus binder treatment. During this period she did not develop any new calciphylaxis lesions or sodium thiosulfate adverse effects. Furthermore, at one occasion when she stopped the treatment for a month due to unavailability of the drug, she started feeling the characteristic intradialysis pain on her abdominal calciphylaxis scars, which disappeared after restarting oral sodium thiosulphate. [6],[7],[8],[9] We believe that oral sodium thiosulfate could be a potential preventive treatment for calciphylaxis in dialysis patients.
 References | |  |
| 1. | Bondi E, Margolis D, Lazarus G. Panniculitis. In Freedberg I, Eisen A, Wolff K, Austen K, Goldsmith L, Katz S, Fitzpatrick T. Fitzpatrick´s Dermatology in general medicine. New York. Mc Graw -Hill. 1999: 1275-88  |
| 2. | Goodman WG, London G, Amann K, et al. Vascular calcification in chronic kidney disease. Am J Kidney Dis 2004;43(3):572-9. |
| 3. | Yatzidis H. Successful sodium thiosulphate treatment forrecurrent calcium urolithiasis. Clin Nephrol 1985;23(2):63-7. |
| 4. | Yatzidis H, Agroyannis B. Sodium thiosulfate treatment of soft-tissue calcifications in patients with end-stage renal disease. Peritoneal Dial Bull 1987;7(4):250-2. |
| 5. | Lacy C, Armstrong L, Goldman M, Lance L. Drug Information Handbook International. Hudson. Lexi-Comp. 2004:1399-400 |
| 6. | Papadakis JT, Patrikarea A, Digenis GE, et al. Sodium thiosulfate in the treatment of tumoral calcifications in a hemodialysis patient without hyperparathyroidism. Nephron 1996;72(2): 308-12. |
| 7. | Cicone JS, Petronis JB, Embert CD, et al. Successful treatment of calciphylaxis with intravenous sodium thiosulfate. Am J Kidney Dis 2004;43(6):1104-8. |
| 8. | Brucculeri M, Cheigh J, Bauer G, et al. Longterm intravenous sodium thiosulfate in the treatment of a patient with calciphylaxis. Semin Dial 2005;18(5):431-4. |
| 9. | Guerra G, Shah RC, Ross EA. Rapid resolution of calciphylaxis with intravenous sodium thiosulfate and continuous venovenous haemofiltration using low calcium replacement fluid: Case report. Pharmacol Ther 1984;35: 419-25. |
Correspondence Address:
Carlos Guido Musso
Department of Nephrology, Hospital Italiano de Buenos Aires
Argentina
 Source of Support: None, Conflict of Interest: None  | Check |
PMID: 18711307 
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| Hayden, M.R. and Goldsmith, D.J.A. | | Seminars in Dialysis. 2010; 23(3): 258-262 | | [Pubmed] | | | 7 |
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