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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR Table of Contents   
Year : 2008  |  Volume : 19  |  Issue : 5  |  Page : 820-821
Oral Sodium Thiosulfate Solution as a Secondary Preventive Treatment for Calciphylaxis in Dialysis Patients

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

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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 Top

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  Back to cited text no. 1    
2.Goodman WG, London G, Amann K, et al. Vascular calcification in chronic kidney disease. Am J Kidney Dis 2004;43(3):572-9.  Back to cited text no. 2    
3.Yatzidis H. Successful sodium thiosulphate treatment forrecurrent calcium urolithiasis. Clin Nephrol 1985;23(2):63-7.  Back to cited text no. 3    
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.  Back to cited text no. 4    
5.Lacy C, Armstrong L, Goldman M, Lance L. Drug Information Handbook International. Hudson. Lexi-Comp. 2004:1399-400  Back to cited text no. 5    
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.  Back to cited text no. 6    
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.  Back to cited text no. 7    
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.  Back to cited text no. 8    
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.  Back to cited text no. 9    

Correspondence Address:
Carlos Guido Musso
Department of Nephrology, Hospital Italiano de Buenos Aires
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Source of Support: None, Conflict of Interest: None

PMID: 18711307

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