Saudi Journal of Kidney Diseases and Transplantation

LETTER TO THE EDITOR
Year
: 2008  |  Volume : 19  |  Issue : 5  |  Page : 820--821

Oral Sodium Thiosulfate Solution as a Secondary Preventive Treatment for Calciphylaxis in Dialysis Patients


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

Correspondence Address:
Carlos Guido Musso
Department of Nephrology, Hospital Italiano de Buenos Aires
Argentina




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;19:820-821


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 2019 Aug 25 ];19:820-821
Available from: http://www.sjkdt.org/text.asp?2008/19/5/820/42471


Full Text

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

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