The Use of Intravenous Sodium Thiosulfate for the Treatment of Calciphylaxis in an Elderly Peritoneal Dialyisis Patient

Abstract

Calciphylaxis is a very painful condition which occurs in about 1-4% of patients with end stage renal disease. The use of Sodium Thiosulfate for the treatment of Calciphylaxis in patients undergoing peritoneal dialysis has not been widely studied. Most of the literature focuses on its use in hemodialysis patients. Case presentation: Mrs. X is an 85 year old lady with end stage renal disease who lives in a rural community in Northern British Columbia. She was started on hemodialysis in May 2006 and switched to continuous cycling peritoneal dialysis (CCPD) 16 months later to limit her travel time. Our patient had an atypical presentation:▶Calcium X Phosphorous product within KDOQI guidelines of <4.4 since starting CCPD▶On no binder therapy▶Low parathyroid hormone▶No diabetes▶BMI = 18.8 Our primary goal for Mrs. X was pain management. Despite the regular use of narcotics, we were unable to achieve adequate pain control. Changing her back to hemodialysis was not an option. Several case reports reviewed the use of Sodium Thiosulfate as a treatment option. Based on a review of literature and a treatment cost evaluation, it was decided to give 5 g Sodium Thiosulfate IV 3 X/week for an initial 3 months while keeping her on CCPD with one daytime exchange. After 3 weeks of treatment, she no longer required oxycocet or her fentanyl patch for pain. Her treatment was stopped after 6 months when her wound was healed. Mrs. X's overall quality of life has improved greatly with this treatment.