What is the role of sodium thiosulfate in the treatment of calciphylaxis?

Updated: Feb 24, 2020
  • Author: Julia R Nunley, MD; Chief Editor: Dirk M Elston, MD  more...
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Marked improvement of calciphylaxis has now been reported with the use of intravenous sodium thiosulfate. Sodium thiosulfate is a potent antioxidant, and it also increases the solubility of calcium deposits. Success has been reported in uremic and nonuremic calciphylaxis. [8, 53, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70]

Calciphylaxis therapy with sodium thiosulfate is off-label usage, but reports of success are mounting. A study of 14 patients suggests that several factors may impact patient outcome. [71] Earlier intervention and/or a higher total dose of sodium thiosulfate may be more effective but more poorly tolerated. More obese patients and patients on long-term renal replacement therapy did not fair as well. Success was recently reported in a nonuremic patient treated with intravenous sodium thiosulfate. [72] A multimodality approach using sodium thiosulfate, cinacalcet, and sevelamer has also been used. [73]

Sodium thiosulfate has been administered intravenously, intralesionally, or topically; intraperitoneal administration is not recommended owing to the risk of chemical peritonitis. [24] Sodium thiosulfate has been used in both adults and children. [74] Intravenous doses have varied from 5-75 g after or during hemodialysis in adults. The most commonly reported dose has been 25 g after each dialysis. Some have used weight-based dosing (especially in children) at using 12 g/1.7 m2. Infusion times vary from 30-60 minutes. Although generally well tolerated, adverse effects have include nausea with emesis and the development of an anion gap metabolic acidosis that can be managed by altering the bicarbonate level of the dialysate. Symptomatic relief and clinical improvement may occur within 2 weeks. See the Anion Gap calculator.

Early data suggest that intralesional sodium thiosulfate may also be an option. [75]

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