Use of sodium thiosulfate leads to adverse events for patients on peritoneal dialysis
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AUSTIN, Texas — Use of sodium thiosulfate to treat calciphylaxis in patients on peritoneal dialysis can be successful, but adverse effects may occur, according to data presented at the National Kidney Foundation Spring Clinical Meetings.
Sodium thiosulfate for the treatment of calciphylaxis is well studied in patients on hemodialysis but not in patients on peritoneal dialysis, Christy L. Gossett, NP, and colleagues from the Mayo Clinic in Rochester, Minnesota, and Jacksonville, Florida, reported in their poster presentation. Calciphylaxis is a serious condition that is infrequent but occurs from deposits of calcium in the small blood vessels of the skin and other organs, leading to skin ulcers and painful tissue necrosis.
The researchers performed a literature search and found 19 articles on patients treated with peritoneal dialysis receiving sodium thiosulfate. The study review showed that the incidence of calciphylaxis was higher in patients on peritoneal dialysis at 4.1 to 4.2 cases per 1,000 patient years, while only 0.6 to 0.8 cases per 1,000 patient years for patients on hemodialysis.
The exact mechanism of action of sodium thiosulfate for treating calciphylaxis is not completely understood but studies report that it is thought to bind calcium ions in the bloodstream and tissues, preventing the formation of calcium deposits. It also possesses antioxidant and anti-inflammatory properties that promote healing.
Critical insights were revealed and reported in the poster on dosing, route of administration, successful healing and adverse effects. Intraperitoneal dosing in patients (n=5) ranged from 12.5 grams to 25 grams three to four times weekly, with 80% of patients achieving healed wounds.
Of the five patients, 80% had adverse effects and administration of sodium thiosulfate was stopped. In a separate patient group that received sodium thiosulfate IV (n=18), doses ranged from 3.2 grams to 25 grams three times weekly. In this group, 6% required sodium thiosulfate discontinuation and 44% had successfully healed wounds.
Patients who switched from IV to intraperitoneal dosing included two with healed wounds and one patient who died due to sepsis.
The authors concluded that use of sodium thiosulfate in patients on peritoneal dialysis can be successful, but significant adverse effects may occur. Larger studies and pharmacological data need to be completed to determine the optimal dose, efficacy and route, they wrote.
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Gossett CL, et al. #362. Presented at: National Kidney Foundation Spring Clinical Meetings; April 11-15, 2023; Austin, Texas.
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