IV Sodium Thiosulphate Ineffective for Treating Calciphylaxis in Chronic Kidney Disease Patients

A recent systematic review and meta-analysis have shown that intravenous sodium thiosulphate is ineffective in treating calciphylaxis in people with chronic kidney disease (CKD). The study, which consisted of 12 clinical trials, found no significant difference in skin lesion improvement between patients who were treated with sodium thiosulphate and those who were not. Furthermore, 15 studies that looked at the risk of death in patients with CKD who were experiencing calciphylaxis showed no significant difference between those that were treated with sodium thiosulphate and those that were not.

Calciphylaxis and Sodium Thiosulphate Treatment

Calciphylaxis is a medical condition caused by vascular calcification, and patients diagnosed with the condition typically live for about six months. Although sodium thiosulphate is not indicated for calciphylaxis, it has been used off-label for years to help heal wounds and improve pain. Currently, there is no specific treatment approved for CKD-related calciphylaxis, which is more common in patients with kidney failure or on dialysis.

Publication Bias

The study also found that there was a negative correlation between studies that found sodium thiosulphate-related improvement in skin lesions with publication year. This suggests that there may be a publication bias where successful treatment with sodium thiosulphate was more likely to be published in the past, while non-responders have also been published recently.

Further Research Needed

Due to the rare and fatal nature of calciphylaxis, it has been challenging to conduct well-designed, randomized control trials. The study’s authors called for further research, including randomized controlled trials, to determine whether there are any subgroups of CKD patients suffering from calciphylaxis that might benefit from sodium thiosulphate treatment. One study currently underway, the BEAT-CALCI trial, is comparing sodium thiosulphate, magnesium, and vitamin K treatments for patients with calciphylaxis and is expected to be completed at the end of 2026.