Sodium Thiosulphate Shows Limited Efficacy in CKD-Related Calciphylaxis

Researchers found that intravenous sodium thiosulphate failed to treat calciphylaxis in people with chronic kidney disease (CKD).

In a systematic review and meta-analysis, there was no massive contrast in skin sore improvement seen across 12 studies of patients treated with and without IV sodium thiosulphate (risk ratio 1.23, 95% CI 0.85-1.78), tracked down Wen Wen, MD, MMSc, of Beijing Tsinghua Changgung Hospital, and partners.

In 15 studies that looked at this outcome (RR 0.88, 95% CI 0.70-1.10), the group detailed in JAMA Network Openopens, sodium thiosulphate treatment also did not help reduce the risk of death in patients with CKD who were experiencing calciphylaxis.

There was also no significant benefit noted in the few studies that examined overall survival using time-to-event data (HR 0.82, 95% CI 0.57-1.18).

Brought about by vascular calcification, patients diagnosed with calciphylaxis live around a half year, as per the National Kidney Foundation.

Despite not being prescribed for the condition, sodium thiosulphate has long been used for calciphylaxis to aid in wound healing and alleviate pain. There is currently no approved treatment for CKD-related calciphylaxis, which is more prevalent in those on dialysis or with kidney failure.

Similar null discoveries were seen when the studies were reduced to just CKD patients on dialysis experiencing calciphylaxis:

Lesion improvement: RR 0.68 (95% CI 0.41-1.14)
All-cause death: RR 1.15 (95% CI 0.73-1.80).

What Wen’s group did find was a negative correlation between studies that found sodium thiosulphate-related improvement in skin lesions with publication year, implying “a publication bias where successful treatment with STS [sodium thiosulphate] was more likely to be published in the past, while more recently nonresponders have also been published.”

For the 12 studies that measured lesion improvement as a result of interest – – ranging in publication year from 2006 to 2021 – – just a single essentially preferred sodium thiosulphate treatment. This was found in a 2015 study where sore improvement was a relative 86% higher with sodium thiosulphate. In addition, only one of the 15 studies that examined calciphylaxis-related all-cause death in CKD patients found that sodium thiosulphate treatment reduced the risk of death by 27%.

“In case reports and multi-case reports, the effective rates for STS treatment were 67% and 84.4%, respectively,” the researchers pointed out. “Complete and partial wound healing was observed in 80.3% of the patients receiving STS in case reports and case series, and 72.1% of those patients in cohort studies.”

“However, the mortality rate remained high,” they added. “In the largest cohort study of 172 patients treated with STS for calciphylaxis, the mortality rate was 35% at 1 year and 42% for the entire follow-up.”

Wen’s group called for a well-designed randomized control trial because the current data on the effects of sodium thiosulphate on calciphylaxis are at best contradictory and at worst null. They went on to say that this has been difficult to accomplish because of the condition’s rarity and fatality. One phase III trial, the CALISTA trial, was really pulled early as a result of issues enlisting an adequate number of patients.

Wen’s group noted one study – – the BEAT-CALCI trial – – that is in progress, contrasting sodium thiosulphate, magnesium, and vitamin K treatments for patients with calciphylaxis. This study is expected to be finished toward the finish of 2026.

They said they trust these future studies can help pinpoint assuming there are any subgroups of CKD patients experiencing calciphylaxis that could profit from sodium thiosulphate treatment considering the deficiency of treatment options.