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Calciphylaxis: calcific uremic arteriolopathy and the emerging role of sodium thiosulfate
Melvin R Hayden1, David Goldsmith, James R Sowers
1Department of Internal Medicine, Endocrinology Diabetes and Metabolism, Diabetes and Cardiovascular Disease Research Group, University of Missouri School of Medicine, Health Sciences Center, MA410, DC043.00, Columbia, MO 65212, USA. mrh29@usmo.com
Insights
Sodium thiosulfate offers new hope for calciphylaxis (calcific uremic arteriolopathy), a severe condition often seen in kidney disease patients. This established drug shows promise in relieving pain, healing skin ulcers, and reducing mortality from this disorder.
Area of Science:
- Nephrology
- Dermatology
- Vascular Medicine
Background:
- Calciphylaxis (calcific uremic arteriolopathy) is a severe condition characterized by arteriolar calcification, fibrosis, and thrombosis.
- It commonly affects patients with chronic kidney disease, particularly those on renal replacement therapy.
- The condition leads to ischemia, intense pain, tissue necrosis, and nonhealing skin ulcerations, carrying a high mortality rate.
Purpose of the Study:
- To highlight the emerging role of sodium thiosulfate in treating calciphylaxis.
- To discuss the novel application of sodium thiosulfate, an old drug, for this severe disorder.
- To inform physicians about a potentially life-saving treatment option for calciphylaxis.
Main Methods:
- Review of recent case reports and literature on sodium thiosulfate therapy for calciphylaxis.
- Discussion of sodium thiosulfate's established uses (cyanide poisoning, chemotherapy side effects) and its new application.
- Emphasis on combination therapy approaches for calciphylaxis.
Main Results:
- Sodium thiosulfate therapy has demonstrated rapid pain relief in patients with calciphylaxis.
- Healing of skin ulcerations has been observed with sodium thiosulfate treatment.
- Emerging evidence suggests sodium thiosulfate can prevent the high mortality associated with calciphylaxis.
Conclusions:
- Sodium thiosulfate presents a promising new treatment option for calciphylaxis (calcific uremic arteriolopathy).
- Further research is warranted to fully elucidate the benefits and optimal use of sodium thiosulfate in calciphylaxis management.
- This repurposed drug offers a potential avenue to improve outcomes and reduce mortality in patients with this devastating condition.
Abstract:
Calciphylaxis-calcific uremic arteriolopathy, is a serious disorder of arteriolar calcification of the arteriole media and is associated with endovascular fibrosis and thrombosis in subcutaneous adipose tissue. It frequently results in severe ischemia, intense pain, and tissue necrosis with nonhealing skin ulcerations. It usually occurs in chronic kidney disease and especially in patients requiring renal replacement therapy. It is associated with a very high mortality rate, and the number of reports and reviews seemed to have increased over the past 5 years. Advances in therapy and salvaging patients from this high mortality risk have recently been reported with the use of sodium thiosulfate. The new application for this old drug used to treat cyanide poisoning and recently preventing neurotoxic effects resulting in hearing loss in those patients with head and neck cancer receiving cisplatin and carboplatin therapy are discussed. Recently, multiple case reports have demonstrated that sodium thiosulfate therapy has resulted in rapid pain relief, healing of skin ulcerations, and prevention of high mortality risk. This emerging treatment and its success are relatively unknown to many physicians. The purpose of this report is to share with others the emerging role of sodium thiosulfate and its new application as a treatment option to be used in combination with other treatment modalities for calciphylaxis-calcific uremic arteriolopathy. Indeed, as with any new treatment this emerging therapy should be studied in greater detail, but this old drug seems to have a new life in the hands of treating physicians.
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