Abstract: SA-PO857

CKD Patients with Calciphylaxis and Sodium Thiosulfate Treatment: A Systematic Review and Meta-Analysis

Session Information

  • Vascular Calcification
    November 04, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Mineral Disease

  • 1205 Vascular Calcification

Authors

  • Udomkarnjananun, Suwasin, Chulalongkorn University, Bangkok, Thailand
  • Susantitaphong, Paweena, Chulalongkorn University, Bangkok, Thailand
  • Eiam-Ong, Somchai, Chulalongkorn University, Bangkok, Thailand
  • Praditpornsilpa, Kearkiat, Chulalongkorn University, Bangkok, Thailand
Background

Chronic kidney disease (CKD) patients with calcific uremic arteriolopathy (CUA, calciphylaxis) are at high cardiovascular and mortality risks.Sodium thiosulfate (STS) is currently the most common treatment for CUA but the outcome is still unclear.Our objective is to systematically explore the outcome of CUA treatment with STS in CKD patients.

Methods

We searched MEDLINE,Scopus,and Cochrane Central Register of Controlled Trials from 1960 to April 2017 to identify case-control,cohort,and randomized controlled trials reporting the mortality rate of CKD patients with CUA and the outcomes after treated with STS.Only human studies published in English language were included.

Results

From 1,071 articles searched,24 cohort and case-control studies reporting mortality rate of CKD patients with CUA were included into a systematic review.Ten of them were specified on STS treatment outcomes and had enough details for data analysis.No randomized controlled trial were found.There were total 284 patients receiving STS,27.1(22.2-32.7)% were male and 53.1(47.2-58.9)% had diabetes mellitus.The CUA lesions were mainly in the lower extremities (87.3%,63.2-96.5%).Mean accumulated STS dosages were 796±276 grams and mean duration of treatment were 10±2 weeks.After treatment with STS the wound completely resolved in 34.8 (22.6-49.55)% and partially resolved in 35.5 (24.6-48.2)%.The overall mortality rate of CUA patients receiving STS was 57.8 (45.7-68.9)%, as high as the pooled mortality rate from general 1,707 CUA patients (57.2%,49.3-64.8%).The odds ratio for mortality showed no statistical significance between the patients who had received STS and who had not (odds ratio 0.62,95%CI 0.27-1.42).

Conclusion

This is the first systematic review and meta-analysis of STS treatment in CKD patients with CUA.Although about 70% of CUA patients had wound improvement,the mortality was not lowered with STS treatment compared to the general CUA patients.Lacking of controlled trials may limit the evidence of the true efficacy of STS.

Study details
First author, yearBaldwin,2011
(Canada 2007-2010)
Nouredd,2011
(US 2003-2008)
Sood,2011
(Canada 2006-2008)
Malabu,2012
(Australia 2006-2011)
Nigwekar,2012
(US 2006-2009)
Zitt,2013
(Austria 2004-2010)
Lee,2015
(Singapore 2012-2013)
Bourgeois,2016
(Belgium 2009-2014)
McCarthy,2016
(US 1999-2014)
Zhang,2016
(US 2001-2015)
Patients number7 patients received STS14 patients received STS6 patients received STS3 patients received STS
3 patients did not received STS
172 patients received STS27 patients received STS11 patients received STS
1 patients did not received STS
6 patients received STS34 patients received STS
67 patients did not received STS
4 patients received STS
3 patients did not received STS
Patients characteristicsHD 14%
PD 72%
CKD 14%
HD 57%
PD 43%
HD 33%
PD 67%
HD 100%HD 100%HD 85%
PD 15%
HD 58%
PD 33%
Kidney transplantation 8%
HD 33%
PD 17%
Kidney transplantation 50%
Dialysis 59%
CKD 41%
PD 100%
STS dosages and durationDose not described
Duration 8±3.7 weeks
Dose 850±1648 g
Duration not described
Dose 771±253 g
Duration 10.8±3.7 weeks
Total dosages and duration not describedDose 950 g (IQR 425,1975)
Duration 13 weeks
Dose 1268±1555 g
Duration 13.4 weeks (IQR 7.7,19)
Total dosages and duration not describedDose 413±255 g
Duration 5.6±3.9 weeks
Total dosages and duration not describedDose not described
Duration 12 weeks (IQR 11.2,20.4)
Wound outcomeCompletely resolved 86%
Partially resolved 14%
Completely resolved 36%
Partially resolved 36%
Completely resolved 33%
Partially resolved 33%
Resolved 50% in patients with STS treatment
Resolved 100% in patients without STS treatment
Completely resolved 26%
Partially resolved 47%
Completely resolved 52%
Partially resolved 19%
Resolved 65% in patients with STS treatment
Resolved 0% in patients without STS treatment
Completely resolved 33%
Partially resolved 33%
Not describedNot described
Death29%71%50%100% in patients with STS treatment

67% in patients without STS treatment
42%52%82% in patients with STS treatment

100% in patients without STS treatment
67%64.7% in patients with STS treatment

79.1% in patients without STS treatment
75% in patients with STS treatment

67% in patients without STS treatment