Abstract: SA-PO830

Effect of Sodium Thiosulfate on Arterial Stiffness in ESRD Patients Undergoing Chronic Hemodialysis: A Randomized Controlled Trial

Session Information

Category: Dialysis

  • 606 Dialysis: Epidemiology, Outcomes, Clinical Trials - Cardiovascular

Authors

  • Saengpanit, Donlawat, King Chulalongkorn Memorial Hospital, Thai Red Cross Society and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
  • Siribumrungwong, Monchai, Lerdsin Hospital, Bangkok, Thailand
  • Susantitaphong, Paweena, King Chulalongkorn Memorial Hospital, Thai Red Cross Society and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
  • Katavetin, Pisut, King Chulalongkorn Memorial Hospital, Thai Red Cross Society and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
  • Eiam-Ong, Somchai, King Chulalongkorn Memorial Hospital, Thai Red Cross Society and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
  • Tungsanga, Kriang, King Chulalongkorn Memorial Hospital, Thai Red Cross Society and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
  • Sitprija, Visith, Queen Saovabha Memorial Institute, Bangkok, Thailand
  • Praditpornsilpa, Kearkiat, King Chulalongkorn Memorial Hospital, Thai Red Cross Society and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
Background

End-stage renal disease (ESRD) patients undergoing chronic hemodialysis (HD) have an extremely poor cardiovascular outcome. Arterial stiffness (AS), a strong independent predictor of survival in HD patients, is related to vascular calcification (VC). Intravenous (IV) sodium thiosulfate (STS) can prevent VC in animal studies and delay progression of VC in HD patients, likely by cationic chelating and antioxidant properties. The effect of STS on AS has not been assessed in this patient population. This study is the first to evaluate the efficacy of STS on AS in HD patients.

Methods

We enrolled 50 HD patients with AS measured by Cardio-Ankle Vascular Index (CAVI ≥ 8) into an open-label, randomized controlled trial. Patients were allocated to receive IV STS 12.5 gram during the last hour of HD twice weekly for 24 weeks (n=24) or usual care (control; n=26). CAVI, hemodynamics, and biochemical parameters were determined at baseline, 12 weeks and after 24 weeks. (Thai Clinical Trials Registry ID: 20160814001)

Results

All baseline parameters including CAVI (IV STS, 9.33 ± 0.87 vs. control, 9.34 ± 0.94) were comparable. Twenty-four weeks of twice weekly IV STS slightly lowered AS but insignificantly when compared with the control group (mean difference of the change of CAVI between STS and control was -0.53; 95% CI -1.07, 0.02; P = 0.17). Significant improvement of AS was observed in those without diabetes mellitus (DM) (P<0.05). There were no significant changes in hemodynamic parameters in both groups. No significant changes in serum calcium, phosphate, calcium-phosphate product, intact parathyroid hormone, and 25-OH vitamin D levels at baseline and after 24 weeks in both groups were observed. High-sensitivity C-reactive protein was slightly but not significantly decreased in IV STS treated group than the control group. After STS treatment, anion gap significantly increased from baseline (P<0.05).

Conclusion

Intradialytic STS treatment has a trend toward improvement in AS measured by CAVI in HD patients. The subgroup results which demonstrated that ESRD patients without DM are affected differently by STS treatment are interesting and require further study for confirmation.

Funding

  • Government Support - Non-U.S.