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, year | Baldwin,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 number | 7 patients received STS | 14 patients received STS | 6 patients received STS | 3 patients received STS 3 patients did not received STS | 172 patients received STS | 27 patients received STS | 11 patients received STS 1 patients did not received STS | 6 patients received STS | 34 patients received STS 67 patients did not received STS | 4 patients received STS 3 patients did not received STS |
| Patients characteristics | HD 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 duration | Dose 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 described | Dose 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 described | Dose 413±255 g Duration 5.6±3.9 weeks | Total dosages and duration not described | Dose not described Duration 12 weeks (IQR 11.2,20.4) |
| Wound outcome | Completely 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 described | Not described |
| Death | 29% | 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 |