Potential effect of sodium thiosulfate in calciphylaxis: remission of intractable pain

2020 ◽  
pp. 1-10
Author(s):  
Canlin Yang ◽  
Yuqiu Liu ◽  
Haifeng Ni ◽  
Xiaomin Li ◽  
Hong Liu ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Poor Prognosis ◽  
Sodium Thiosulfate ◽  
Potential Effect ◽  
Skin Ulcer ◽  
Intractable Pain ◽  
Maintenance Haemodialysis ◽  
Calcific Uremic Arteriolopathy ◽  
Skin Damages ◽  
Intravenous Sodium

Abstract Calciphylaxis, a rare disease mainly seen in patients with chronic kidney disease, is characterised by ischaemic skin damages and excruciating pain. Calciphylaxis has poor prognosis which often results in amputation and high mortality. Although guidelines for the management of calciphylaxis are not available, sodium thiosulfate has showed efficacy in many clinical reports. We report the case of a 64-year-old advanced calciphylaxis male patient who had two amputations due to intolerable pain manifested as deteriorating ulcer. After he was treated with intravenous sodium thiosulfate (STS), his pain was significantly relieved with a healing trend of the big wound. One more amputation for the remission of intractable pain was avoided. The treatment experience indicates that sodium thiosulfate is of great value in quick pain relief and reducing suffering of calciphylaxis patients. Keywords: Calciphylaxis, Calcific uremic arteriolopathy, Painful skin ulcer, Maintenance haemodialysis, Continuous....

scholarly journals Buprenorphine for Intractable Pain of Skin Ulcer Associated with Calcific Uremic Arteriolopathy (Calciphylaxis): A Case Report

2018 ◽  
Vol 13 (1) ◽  
pp. 63-68
Author(s):  
Terumasa Noike ◽  
Nirou Kikuchi ◽  
Takuya Yanagida ◽  
Hiromichi Seki ◽  
Mai Shiohara ◽  
...  
Keyword(s):  
Case Report ◽  
Skin Ulcer ◽  
Intractable Pain ◽  
Calcific Uremic Arteriolopathy

scholarly journals Successfully Treated Calcific Uremic Arteriolopathy: Two Cases of a High Anion Gap Metabolic Acidosis with Intravenous Sodium Thiosulfate

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Joshua L. Rein ◽  
Kana N. Miyata ◽  
Kobena A. Dadzie ◽  
Steven J. Gruber ◽  
Roxana Sulica ◽  
...  
Keyword(s):  
Wound Healing ◽  
Metabolic Acidosis ◽  
Sodium Thiosulfate ◽  
Anion Gap ◽  
Small Vessels ◽  
First Case ◽  
Dosing Strategies ◽  
Calcific Uremic Arteriolopathy ◽  
Complete Wound Healing ◽  
Intravenous Sodium

Calcific uremic arteriolopathy (CUA) is a rare and potentially fatal disorder of calcification involving subcutaneous small vessels and fat in patients with renal insufficiency. We describe the successful use of intravenous sodium thiosulfate (STS) for the treatment of CUA in two patients. The first case was complicated by the development of a severe anion gap metabolic acidosis, which was accompanied by a seizure. Both patients had complete wound healing within five months. Although STS should be considered in the treatment of CUA, little is known about pharmacokinetics and additional studies are required to determine dosing strategies to minimize severe potential side effects.

scholarly journals Clinical Efficacy and Safety of Sodium Thiosulfate in the Treatment of Uremic Pruritus: A Meta-Analysis of Randomized Controlled Trials

Toxins ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 769
Author(s):  
Ping-Hsun Lu ◽  
Hui-En Chuo ◽  
Ko-Lin Kuo ◽  
Jian-Fu Liao ◽  
Po-Hsuan Lu
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Confidence Interval ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Sodium Thiosulfate ◽  
Controlled Trials ◽  
Uremic Pruritus ◽  
Randomized Controlled ◽  
Intravenous Sodium

Uremic pruritus is a distressful complication of chronic kidney disease and results in impaired quality of life and higher mortality rates. Intravenous sodium thiosulfate has been reported to alleviate pruritus in hemodialysis patients. We performed a systematic review and meta-analysis to estimate the efficacy of intravenous sodium thiosulfate in patients with uremic pruritus. A systematic search of electronic databases up to June 2021 was conducted for randomized controlled trials that evaluated the clinical effects of sodium thiosulfate in the management of patients with uremic pruritus. Two reviewers selected eligible articles and evaluated the risk of bias; the results of pruritus assessment and uremic pruritus-related laboratory parameters in selected studies were analyzed. There are four trials published between 2018 and 2021, which include 222 participants. The sodium thiosulfate group displayed significant decrease in the pruritus score (standardized mean difference = −3.52, 95% confidence interval = −5.63 to −1.41, p = 0.001), without a significant increase in the adverse effects (risk ratio = 2.44, 95% confidence interval = 0.37 to 15.99, p = 0.35) compared to the control group. Administration of sodium thiosulfate is found to be a safe and efficacious complementary therapy in improving uremic pruritus in patients with chronic kidney disease.

scholarly journals Calciphylaxis: a rare but potentially fatal event of chronic kidney disease. Case report

2013 ◽  
Vol 88 (6 suppl 1) ◽  
pp. 44-47 ◽  
Author(s):  
Silvio Alencar Marques ◽  
Aline Cruz Kakuda ◽  
Thais Jung Mendaçolli ◽  
Luciana P. Fernandes Abbade ◽  
Mariângela Esther Alencar Marques
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Systemic Disease ◽  
Systemic Infection ◽  
Skin Ulcer ◽  
Advanced Chronic Kidney Disease ◽  
Reticular Pattern ◽  
Disease Case ◽  
Calcific Uremic Arteriolopathy ◽  
Mural Calcification

Calciphylaxis or calcific uremic arteriolopathy is a rare cutaneous-systemic disease occurring in patients with advanced chronic kidney disease. The classical clinical picture is that of a necrotic and progressive skin ulcer of reticular pattern, mostly in the lower legs and susceptible to local infection. It is a product of mural calcification and occlusion of cutaneous and sub-cutaneous arteries and arterioles. The authors report the case of a 73-year-old male patient in his late stage of renal disease presenting severe necrotic cutaneous ulcers on lower legs followed by local and systemic infection and death due to sepse after parathyroidectomy.

Potential effect of pharmaceutical care to improve outcomes in patients with chronic kidney disease-mineral bone disorder in Sulaimani dialysis centers

2020 ◽  
pp. 82-94
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Pharmaceutical Care ◽  
Biochemical Parameters ◽  
Positive Impact ◽  
Potential Effect ◽  
Care Group ◽  
Mineral Bone Disorder ◽  
Bone Disorder

Objective: the present study was aimed to evaluate the role of pharmaceutical services in improving the outcome of mineral bone disorder in patients with advanced chronic kidney disease. Methodology: One hundred and twenty patients with chronic kidney disease-mineral bone disorder (CKD-MBD) screened for eligibility, seventy-six patients enrolled in the study and randomly allocated into two groups: pharmaceutical care and usual care, both groups interviewed by the pharmacist using specific questionnaire for assessing the quality of life (QoL). All the drug related problems (DRPs) including drug-drug interactions (DDIs) were recorded by the pharmacist. Blood samples were collected and utilized for analyzing the levels of vitamin D, phosphorous, calcium, albumin and parathyroid hormone at baseline and three months after. The pharmaceutical care group received all the educations about their medications and how to minimize DRPs; improve the QoL. Additionally, the pharmaceutical intervention included correcting the biochemical parameters. Results: Pharmaceutical care significantly improved patients QoL and minimized DRPs and DDIs. It was also effective in improving the biochemical parameters. Conclusion: Pharmaceutical care has a positive impact on improving the outcome of patients with CKD-MBD through attenuating DRPs, improving the biochemical parameters and the QoL.

scholarly journals Calcific Uremic Arteriolopathy: Pathophysiology, Reactive Oxygen Species and Therapeutic Approaches

2010 ◽  
Vol 3 (2) ◽  
pp. 109-121 ◽  
Author(s):  
Kurt M. Sowers ◽  
Melvin R. Hayden
Keyword(s):  
Oxidative Stress ◽  
Reactive Oxygen Species ◽  
Chronic Kidney Disease ◽  
Smooth Muscle ◽  
Kidney Disease ◽  
Vascular Smooth Muscle ◽  
Reactive Oxygen ◽  
Morbidity And Mortality ◽  
Oxygen Species ◽  
Calcific Uremic Arteriolopathy

Calcific uremic arteriolopathy (CUA)/calciphylaxis is an important cause of morbidity and mortality in patients with chronic kidney disease requiring renal replacement. Once thought to be rare, it is being increasingly recognized and reported on a global scale. The uremic milieu predisposes to multiple metabolic toxicities including increased levels of reactive oxygen species and inflammation. Increased oxidative stress and inflammation promote this arteriolopathy by adversely affecting endothelial function resulting in a prothrombotic milieu and significant remodeling effects on vascular smooth muscle cells. These arteriolar pathological effects include intimal hyperplasia, inflammation, endovascular fibrosis and vascular smooth muscle cell apoptosis and differentiation into bone forming osteoblast-like cells resulting in medial calcification. Systemic factors promoting this vascular condition include elevated calcium, parathyroid hormone and hyperphosphatemia with consequent increases in the calcium × phosphate product. The uremic milieu contributes to a marked increased in upstream reactive oxygen species—oxidative stress and subsequent downstream increased inflammation, in part, via activation of the nuclear transcription factor NFκB and associated downstream cytokine pathways. Consitutive anti-calcification proteins such as Fetuin-A and matrix GLA proteins and their signaling pathways may be decreased, which further contributes to medial vascular calcification. The resulting clinical entity is painful, debilitating and contributes to the excess morbidity and mortality associated with chronic kidney disease and end stage renal disease. These same histopathologic conditions also occur in patients without uremia and therefore, the term calcific obliterative arteriolopathy could be utilized in these conditions.

scholarly journals Removing the problem: parathyroidectomy for calciphylaxis

2018 ◽  
Vol 11 (1) ◽  
pp. e226696 ◽  
Author(s):  
Mohamed Hassanein ◽  
Heather Laird-Fick ◽  
Richa Tikaria ◽  
Saleh Aldasouqi
Keyword(s):  
Treatment Options ◽  
Sodium Thiosulfate ◽  
Skin Lesions ◽  
Phosphate Binders ◽  
Treatment Resistant ◽  
Hungry Bone Syndrome ◽  
Calcific Uremic Arteriolopathy ◽  
Stage Renal Disease ◽  
End Stage ◽  
Hungry Bone

Calcific uremic arteriolopathy (CUA), widely known as calciphylaxis, is a rare and lethal disease that usually affects patients with end-stage renal disease. It is characterised by widespread vascular calcification leading to tissue ischaemia and necrosis and formation of characteristic skin lesions with black eschar. Treatment options include sodium thiosulfate, cinacalcet, phosphate binders and in resistant cases, parathyroidectomy. We report a case of recurrent, treatment-resistant CUA successfully treated with parathyroidectomy. Her postoperative course was complicated by hungry bone syndrome and worsening of her wounds before they completely healed. We then discuss the morbidity of CUA, including the controversy around the use of parathyroidectomy and risk of aggressive management of hungry bone syndrome.

38: Calcific Uremic Arteriolopathy (CUA) Successfully Treated with Intravenous Sodium Thiosulphate

2008 ◽  
Vol 51 (4) ◽  
pp. B37
Author(s):  
Ion D. Bucaloiu ◽  
Evan Norfold ◽  
Nektarios Lountzis ◽  
Fred O. Miller ◽  
Dirk Elston
Keyword(s):  
Sodium Thiosulphate ◽  
Calcific Uremic Arteriolopathy ◽  
Intravenous Sodium

The Use of Intravenous Sodium Thiosulfate for the Treatment of Calciphylaxis in an Elderly Peritoneal Dialyisis Patient

2010 ◽  
Vol 20 (2) ◽  
pp. 137
Author(s):  
Stefanie Finch ◽  
Irene Aspden ◽  
Lyn Johnson ◽  
Khalid Bashir
Keyword(s):  
Sodium Thiosulfate ◽  
Intravenous Sodium
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