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Sodium thiosulfate is effective in calcific uremic arteriolopathy complicating chronic hemodialysis
Stéphanie Malbos1, Pablo Ureña-Torres2, Thomas Bardin3
1Service de rhumatologie, pôle appareil locomoteur, centre Viggo-Petersen, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France.
Insights
Sodium thiosulfate therapy offers a promising treatment for calcific uremic arteriolopathy (CUA), a severe complication in chronic kidney disease (CKD) patients. This case series shows rapid resolution of painful skin necrosis with minimal side effects.
Area of Science:
- Nephrology
- Dermatology
- Vascular Medicine
Background:
- Calcific uremic arteriolopathy (CUA), also known as calciphylaxis, is a devastating complication of advanced chronic kidney disease (CKD) and dialysis.
- Effective treatment options for CUA are limited, and the condition carries a high mortality rate.
Observation:
- This study reports on four patients (3 female, 1 male; aged 49-91) with CUA, experiencing painful skin necrosis on lower limbs, fingers, or breast.
- The patients had end-stage CKD due to nephroangiosclerosis or diabetic nephropathy, with CUA lesions developing 1-6.5 years after starting hemodialysis.
- Three patients had secondary local superinfections of the CUA lesions.
Findings:
- Intravenous sodium thiosulfate was administered at 12.5-25g post-hemodialysis for 12-24 weeks.
- All four patients experienced complete resolution of pain and trophic disorders.
- Reported side effects included nausea and vomiting in two patients and a mild blood pressure decrease in one patient.
Implications:
- Sodium thiosulfate demonstrates potential as an effective therapeutic agent for calcific uremic arteriolopathy.
- The observed rapid resolution and lack of recurrence suggest a favorable risk-benefit profile for sodium thiosulfate in CUA management.
- Further investigation is warranted to confirm these findings in larger clinical trials for CUA treatment.
Background:
Calcific uremic arteriolopathy (CUA) or calciphylaxis is a severe complication of advanced chronic kidney disease (CKD) and dialysis. Few effective treatments are available and the mortality rate is high. We report 4 cases in which sodium thiosulfate therapy was rapidly effective.
Cases:
Sodium thiosulfate therapy was given to 4 Caucasian patients (3 females and 1 male aged 49 to 91 years) with CUA. The causes of end-stage CKD were nephroangiosclerosis (n=2) and diabetic nephropathy (n=2). The lesions developed 1 to 6.5 years after the initiation of hemodialysis and involved the lower limbs in 2 patients, the fingers in 1 patient, and a breast in the remaining patient. They were responsible for pain and skin necrosis in all 4 patients. Local superinfection occurred in 3 patients. Intravenous sodium thiosulfate was given in a dosage of 12.5 to 25g after each hemodialysis session, for 12 to 24 weeks. The pain and trophic disorders resolved fully in all 4 patients. The side effects consisted of nausea and vomiting (n=2) and a moderate blood pressure decrease (n=1). No recurrences were noted during the follow-up of 5 to 17 months after treatment discontinuation.
Conclusion:
The findings from this small case-series suggest that sodium thiosulfate may hold promise for the treatment of CUA.
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