Use of sodium thiosulphate in a multi-interventional setting for the treatment of calciphylaxis in dialysis patients

Zitt, Emanuel; König, Mathias; Vychytil, Andreas; Auinger, Martin; Wallner, Manfred; Lingenhel, Gernot; Schilcher, Gernot; Rudnicki, Michael; Salmhofer, Hermann; Lhotta, Karl

doi:10.1093/ndt/gfs548

Cited by 79 publications

(90 citation statements)

References 35 publications

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“…Patients can present with hemorrhagic vesicles/bullae that precede the progression to necrosis and commonly develop painful, irregularly shaped, nonhealing ulcers. Lesion distribution, specifically proximal lesions (lesions on the trunk, thighs, and upper arms) versus distal lesions (lesions on the calves and forearms), does not seem to be a clear prognostic indicator as previously thought (69,74,80). Systemic symptoms secondary to vascular and extravascular calcification of internal organs and soft tissues may also occur.…”

Section: Metastatic Calcificationmentioning

confidence: 75%

“…CKD/ESRD, dialysis therapy, and commonly occurring comorbid conditions, like hypertension, hypercholesterolemia, obesity, and diabetes mellitus, increase oxidative stress (69,74,76,80). Vascular calcification is promoted in the presence of increased oxidative stress by reactive oxygen species that also leads to a state of systemic inflammation, which is evidenced by increased levels of TNF-a, IL-1, and IL-6 (76).…”

Section: Metastatic Calcificationmentioning

confidence: 99%

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Cutaneous Manifestations of ESRD

Galperin

Cronin

Leslie

2014

Clinical Journal of the American Society of Nephrology

193

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SummaryA broad range of skin diseases occurs in patients with ESRD: from the benign and asymptomatic to the physically disabling and life-threatening. Many of them negatively impact on quality of life. Their early recognition and treatment are essential in reducing morbidity and mortality. The cutaneous manifestations can be divided into two main categories: nonspecific and specific. The nonspecific manifestations are commonly seen and include skin color changes, xerosis, half-and-half nails, and pruritus. The specific disorders include acquired perforating dermatosis, bullous dermatoses, metastatic calcification, and nephrogenic systemic fibrosis. This review article describes these conditions and considers the underlying pathophysiology, clinical presentations, diagnosis, and treatment options.

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Section: Metastatic Calcificationmentioning

confidence: 75%

Section: Metastatic Calcificationmentioning

confidence: 99%

Cutaneous Manifestations of ESRD

Galperin

Cronin

Leslie

2014

Clinical Journal of the American Society of Nephrology

193

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“…The effect of sodium thiosulfate has been reported to rapidly bring relief from severe pain within days to weeks and to heal skin ulcerations within weeks to months [6,9]. The adverse effects of intravenous sodium thiosulfate can be obstacles.…”

Section: Discussionmentioning

confidence: 99%

“…It is not possible to distinguish which cases may be sensitive to sodium thiosulfate. A retrospective study [9] showed that a delay in diagnosis and treatment, or the complications of diabetes, coronary artery disease, peripheral artery disease, or heart failure was associated with poor prognosis. In this case, we speculated that the complications of diabetes and ASO with APS were one of the reasons for the ineffectiveness of sodium thiosulfate.…”

Section: Discussionmentioning

confidence: 99%

Calciphylaxis induced by warfarin therapy in a patient with anti-phospholipid antibody syndrome associated with systemic lupus erythematosus

et al. 2014

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Calciphylaxis is a life-threatening complication of end-stage kidney disease (ESKD) and leads to cutaneous necrosis and gangrene. Various risk factors for calciphylaxis have been reported, and warfarin therapy is a particularly strong trigger. Here we report the case of 50-yearold woman with ESKD and systemic lupus erythematosus who developed calciphylaxis after anti-thrombotic therapy, including warfarin, for ischemic skin ulcers due to arteriosclerosis obliterans and anti-phospholipid antibody syndrome. Although warfarin improved the thrombotic skin ulcers, it might also be a trigger for calciphylaxis. Discontinuation of the warfarin and the addition of lowdensity lipoprotein apheresis and sodium thiosulfate infusion failed to improve the gangrene; eventually, her legs had to be amputated to prevent lethal infection. The histology of the dermal and soft tissue obtained from the amputated legs showed typical findings of calciphylaxis. Warfarin is a vitamin K antagonist with inhibitory effects on the calcification of regulatory proteins, such as matrix Gla protein and fetuin-A. Therefore, the warfarin therapy might have induced calciphylaxis in our patient.

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“…In zwei unkontrollierten Fallserien mit Kalziphylaxiepatienten aus Österreich (n = 27) [25] und aus den USA (n = 172) [16] …”

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Kalziphylaxie

Brandenburg

Martin

Sohn³

et al. 2015

Dtsch med Wochenschr

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Die Kalziphylaxie, auch kalzifizierende urämische Arteriolopathie ("calcific uremic arteriolopathy", CUA), betrifft vorwiegend Patienten mit terminaler Niereninsuffizienz. Die schwerwiegende, gefährliche Erkrankung ist selten: 1 % der Dialysepatienten erkranken pro Jahr. Ihre besonderen Eigenschaften rücken die Kalziphylaxie in den Fokus auch des allgemeinen klinischen und wissenschaftlichen Interesses.

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Use of sodium thiosulphate in a multi-interventional setting for the treatment of calciphylaxis in dialysis patients

Abstract: Calciphylaxis remains a serious complication with high mortality. Early and consistent therapy including STS may help to improve the disease outcome.

Cited by 79 publications

References 35 publications

Cutaneous Manifestations of ESRD

Cutaneous Manifestations of ESRD

Calciphylaxis induced by warfarin therapy in a patient with anti-phospholipid antibody syndrome associated with systemic lupus erythematosus

Kalziphylaxie

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