Sodium Thiosulfate for Calciphylaxis

Calciphylaxis is a rare but severe dermatologic condition affecting end-stage renal disease individuals for reasons which remain obscure. Histologic biopsy is the gold-standard for making the diagnosis; it typically demonstrates calcification within the media of small and medium-sized arterioles with intimal hyperplasia and fibrosis, leading to its other name, calcific uremic arteriolopathy.

Treatment strategies for calciphylaxis remain a challenge for this condition, and for the most part involves supportive care with antibiotics as necessary, pain control, and judicious management of serum calcium and phosphorus levels. One relatively recent potential therapy is sodium thiosulfate. Although its use is still considered "off-label", there have been some encouraging case reports and also animal studies to support its beneficial effect on pathologic calcification.

For those who wish to try sodium thiosulphate infusions, iv doses generally vary from 5-25 grams after or during dialysis over 30-60 minutes. Although generally well-tolerated, GI effects as well as an anion gap metabolic acidosis (due to the thiosulphate moiety) have been reported as side effects.