Sodium Thiosulfate Therapy for Calcific Uremic Arteriolopathy
Sodium Thiosulfate Therapy for Calcific Uremic Arteriolopathy
复制标题
DOI：
10.2215/cjn.09880912
复制
发表时间：
2013-07-01
影响因子：
9.8
通讯作者：
Lacson, Eduardo, Jr.
中科院分区：
文献类型：
--
作者：
Nigwekar, Sagar U.;Brunelli, Steven M.;Lacson, Eduardo, Jr.
背景与目的钙化性尿毒症动脉病(CUA)通常是一种致命的疾病，目前尚无有效的治疗方法。多个病例报告和病例系列描述了静脉注射硫代硫酸钠(STS)在CUA中的应用，但没有研究系统地评估这种治疗。设计、设置、参与者和测量：这项研究包括172名在2006年8月至2009年6月期间在费森尤斯北美医疗保健中心接受CUA和STS治疗的维持性血液透析患者。在这些人中，85%完成了STS治疗。临床、实验室和死亡率数据从临床信息系统中提取。对发送给治疗医生的关于患者水平结果的调查问卷的回复可供53名患者使用。对CUA损害和死亡率的影响被总结为CUA结果。相关的实验室测量、体重(使用STS前、中、后的两两比较)和不良事件被总结为安全参数。结果队列的平均年龄为55岁，74%的患者是女性。STS剂量中位数为25g，中位数为38次。在接受调查的患者中，CUA完全缓解26.4%，显著改善18.9%，改善28.3%，无效5.7%；其余患者(20.8%)反应不详。接受STS治疗的患者一年死亡率为35%。不良反应、实验室异常和与体重相关的变化都很轻微。在完成治疗的患者中，STS患者的血磷(P=0.02)和甲状旁腺激素(P=0.01)显著降低。结论尽管缺乏确凿的证据证明其有效性，但大多数接受STS治疗的患者在本研究中显示出临床上的改善。
Background and objective Calcific uremic arteriolopathy (CUA) is an often fatal condition with no effective treatment. Multiple case reports and case series have described intravenous sodium thiosulfate (STS) administration in CUA, but no studies have systematically evaluated this treatment.Design, setting, participants, & measurements This study included 172 patients undergoing maintenance hemodialysis who had CUA and were treated with STS between August 2006 and June 2009 at Fresenius Medical Care North America. Of these, 85% completed STS therapy. Clinical, laboratory, and mortality data were abstracted from clinical information systems. Responses to survey questionnaires sent to treating physicians regarding patient-level outcomes were available for 53 patients. Effect on CUA lesions and mortality were summarized as CUA outcomes. Relevant laboratory measures, weight (using pairwise comparisons of values before, during, and after STS), and adverse events were summarized as safety parameters.Results Mean age of the cohort was 55 years, and 74% of patients were women. Median STS dose was 25 g, and median number of doses was 38. Among surveyed patients, CUA completely resolved in 26.4%, markedly improved in 18.9%, improved in 28.3%, and did not improve in 5.7%; in the remaining patients (20.8%), the response was unknown. One-year mortality in patients treated with STS was 35%. Adverse events, laboratory abnormalities, and weight-related changes were mild. Significant reductions in serum phosphorous (P=0.02) and parathyroid hormone (P=0.01) were noted during STS treatment in patients who completed the therapy.Conclusions Although conclusive evidence regarding its efficacy is lacking, a majority of patients who received STS demonstrated clinical improvement in this study.