Effects of Sodium Thiosulfate on Vascular Calcification in End-Stage Renal Disease: A Pilot Study of Feasibility, Safety and Efficacy

Abstract

Background and Objectives: Vascular calcification is a major contributor to morbidity and mortality in hemodialysis. The objective of this pilot study was to determine the feasibility, safety and efficacy of sodium thiosulfate (STS) in the progression of vascular calcification in hemodialysis patients. Methods: Chronic hemodialysis patients underwent a battery of cardiovascular tests. Those with coronary artery calcium (Agatston scores >50) received intravenous STS after each dialysis for 5 months (n = 22) and the tests were repeated. Changes in MDCT-determined calcification were assessed as the mean annualized rate of change in 3 vascular beds (coronary, thoracic and carotid arteries) and in L1-L2 vertebral bone density. Results: Although individual analyses showed coronary artery calcification progression in 14/22 subjects, there was no progression in the mean annualized rate of change of vascular calcification in the entire group. The L1-L2 vertebral bone density showed no changes. There were no correlations between rates of progression of vascular calcification and phosphorus, fetuin or C-reactive protein levels. Changes in coronary artery calcification scores correlated with those of the thoracic aorta. Conclusion: STS treatment is feasible, appears safe and may decrease the rate of progression of vascular calcification in hemodialysis patients. A large, randomized, controlled trial is warranted.

Management of Extravasation Injuries: A Focused Evaluation of Noncytotoxic Medications

“…Treatment experience with this drug is limited to a single pediatric case report 59 and experience with the drug in the management of renal calciphylaxis. 60 Calcium thiosulfate salts have high solubilities, allowing for the dissolution of precipitated calcium products. Sodium thiosulfate is most commonly dosed as 12.5-25 g intravenously over 30 minutes 3 times/week, with titration based on gastrointestinal tolerability.…”

“…Sodium thiosulfate is most commonly dosed as 12.5-25 g intravenously over 30 minutes 3 times/week, with titration based on gastrointestinal tolerability. 60 Patients should be monitored for hypocalcemia, nausea, or the development of anion gap acidosis. 60 Despite treatment, complete resolution may take several months of therapy.…”

“…60 Patients should be monitored for hypocalcemia, nausea, or the development of anion gap acidosis. 60 Despite treatment, complete resolution may take several months of therapy. 59 …”

Impact of vascular calcification on cardiovascular mortality in hemodialysis patients: clinical significance, mechanisms and possible strategies for treatment

“…Sodium thiosulfate (STS) is a chelating agent and has been applied for calcific uremic arteriolopathy [126,127]. Calcium-thiosulfate complex is more soluble than calcium oxalate and calcium phosphate, and STS has antioxidant activity [128,129].…”

Lowering vascular calcification burden in chronic kidney disease: Is it possible?

“…STS is readily cleared by dialysis [69] . In two preliminary studies in hemodialysis patients, STS was able to delay the progression of CAC after 4-5 mo of twice weekly intravenous administration but with a decline of hip bone mineral density in one study [67,70] . Larger studies are required to confirm the efficacy of STS on vascular calcification.…”