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Kidney Week

Abstract: FR-PO444

Avoidance of the Third Amputation with Remission of Intolerable Pain by Sodium Thiosulfate Administration in a Severe Calciphylaxis Patient

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Yang, Canlin, Institute of Nephrology, Zhong Da Hospital, Southeast University School of Medicine, Nanjing, China
  • Liu, Yuqiu, Institute of Nephrology, Zhong Da Hospital, Southeast University School of Medicine, Nanjing, China
  • Ni, Haifeng, Institute of Nephrology, Zhong Da Hospital, Southeast University School of Medicine, Nanjing, China
  • Liu, Bi-Cheng, Zhong Da Hospital, Southeast University Medical School, Nanjing, JIANGSU , China
  • Zhang, Xiaoliang, Institute of Nephrology, Zhong Da Hospital, Southeast University School of Medicine, Nanjing, China
Introduction

Calciphylaxis is a rare but fatal vascular calcification disease characterized by ischemic skin damage and severe pain, often leading to amputation. Currently, there is no specific therapy, but sodium thiosulfate (STS) shows potential curative effects in many related reports. We report a calciphylaxis patient with recurrent skin necrosis which seems the third amputation is inescapable. STS significantly relives the sharp pain and delays deterioration of skin ulcer.

Case Description

A 64-year-old Chinese male with 23-year hemodialysis history had recurrent and progressively worsen acro-skin ulcer accompanied by extremely pain. His highest pain score for numeric pain rating scale (NRS) was 9, which made him behave suicidal tendency. He had twice amputations of left fingers and right lower limb, there is still an emerging ulcer on his left heel (Fig.1) with unmanageable pain. His previous amputating wound was also poor-healed after half a year of surgery. X-rays showed the large vessel calcification (red arrows) which suspected of supplying blood at the necrotic site(Fig.2). A skin biopsy on his amputated right lower leg showed extensive calcium deposition in small vessel walls(Fig.3). He was diagnosed as severe calciphylaxis and we conducted a comprehensive therapy based on intravenous STS with the daily increasing dose from 3.2 g/d to maintain with 6.4 g/d after 5 days. After one-week treatment, the patient felt pain significantly relieved (Table) and 3 months later, his amputating wound gradually crusted so that a third amputation was avoided.

Discussion

Although there is no large randomized clinical trial to confirm the effect of STS in calciphylaxis patients, the use of STS significantly reduces pain and the patient avoids the third amputation. It is suggested that STS also has a certain therapeutic effect on severe calciphylaxis, which mainly relies on relieving pain and delaying the progression of skin ulcers.