Use of sodium thiosulphate in a multi-interventional setting for the treatment of calciphylaxis in dialysis patients

Nephrol Dial Transplant. 2013 May;28(5):1232-40. doi: 10.1093/ndt/gfs548. Epub 2013 Jan 4.


Background: Calciphylaxis is a life-threatening complication in patients with end-stage renal disease (ESRD). No established therapy exists so far. The aim of the present study was to determine the therapeutic response to a multi-interventional treatment regimen with consistent use of sodium thiosulphate (STS) in an Austrian cohort of calciphylaxis patients.

Methods: We retrospectively collected demographic, clinical and laboratory data on 27 calciphylaxis patients treated with STS at seven Austrian dialysis centres between June 2004 and November 2010.

Results: Twenty-seven dialysis patients (68 ± 12 years) were treated with STS for a median (25th, 75th percentile) of 96 (54, 133) days. Seven patients (26%) suffered from proximal-type, and 20 patients (74%) from distal-type calciphylaxis. Fourteen patients (52%) showed a complete remission, five patients (19%) a partial remission and eight patients (30%) progression that resulted in amputation in four patients. During a median follow-up of 101 (79, 273) days, 14 patients died (52%). Non-survivors were older (P = 0.04), showed higher CRP values (P = 0.04), presented more frequently with proximal-type calciphylaxis (P = 0.03), had a higher disease severity score at diagnosis (P = 0.01), were treated more often with antibiotics (P = 0.01) and cinacalcet (P = 0.03) and had a lower remission rate during treatment (P = 0.004) than did survivors. The use of antibiotics and cinacalcet, disease severity at diagnosis and remission rates were found to be significant survival predictors in logistic regression analysis.

Conclusions: Calciphylaxis remains a serious complication with high mortality. Early and consistent therapy including STS may help to improve the disease outcome.

Keywords: calcific uraemic arteriolopathy; calciphylaxis; dialysis; end-stage renal disease; sodium thiosulphate.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Calciphylaxis / drug therapy*
  • Calciphylaxis / etiology
  • Calciphylaxis / mortality
  • Chelating Agents / therapeutic use*
  • Female
  • Follow-Up Studies
  • Humans
  • Kidney Failure, Chronic / complications
  • Male
  • Middle Aged
  • Prognosis
  • Renal Dialysis / mortality*
  • Retrospective Studies
  • Survival Rate
  • Thiosulfates / therapeutic use*


  • Chelating Agents
  • Thiosulfates
  • sodium thiosulfate