2021 年 2 巻 1 号 p. 7-14
Background: Currently, there is no standardized treatment protocol on the use of sodium thiosulfate for calciphylaxis. This study may be the first to evaluate the efficacy and safety of treatment with sodium thiosulfate in Japanese patients.
Methods: To avoid side effects, we started intravenous sodium thiosulfate at a low daily dosage (10 g/day) and gradually increased it. In case 1 (a non-dialysis patient), the initial dose was 10 g/day. In cases 2 and 3 (both dialysis patients), intravenous sodium thiosulfate was started at a dose of 10 g after each dialysis, which was gradually increased. In cases 1 and 3, intralesional sodium thiosulfate was incorporated.
Results: After initiating treatment with sodium thiosulfate, a decrease in ulcer area was observed in all three patients. On the other hand, patients experienced nausea, metabolic acidosis, and disturbance of consciousness. The decrease in pH after the initiation of sodium thiosulfate treatment was statistically significant (mean decrease=-0.011, P<0.05). In addition, pH values tended to show an inverse correlation with the daily dosage during intravenous sodium thiosulfate treatment. Disturbance of consciousness was observed in two out of three patients at the same time as acidosis. However, the cause was thought to be sepsis and/or discontinuation of dialysis.
Conclusions: Sodium thiosulfate can be effective in Japanese patients, even with a lower daily dosage than that used in other countries. Careful monitoring of potential side effects is needed.