Division of Nephrology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Nephrol Dial Transplant. 2010 Jun;25(6):1923-9. doi: 10.1093/ndt/gfp755. Epub 2010 Jan 18.
Coronary artery calcification (CAC) is prevalent among haemodialysis patients and predicts cardiovascular mortality. In addition to modifying traditional cardiovascular risk factors, therapy aimed at lowering serum phosphate and calcium-phosphate product has been advocated. Sodium thiosulfate, through its chelating property, removes calcium from precipitated minerals decreasing calcification burden in calcific uraemic arteriolopathy and soft tissue calcification. The effect of sodium thiosulfate on CAC in haemodialysis patients has never been studied.
Eighty-seven stable chronic haemodialysis patients underwent multi-row spiral computed tomography and bone mineral density (BMD) measurement. Patients with a CAC score >or=300 were included to receive intravenous sodium thiosulfate infusion twice weekly post-haemodialysis for 4 months. CAC and BMD were re-evaluated at the end of the treatment course.
Progression of CAC occurred in 25% and 63% of the patients in the treatment and control group, respectively (P = 0.03). CAC score was unchanged in the treatment group but increased significantly in the control group. BMD of the total hip declined significantly in the treatment group. In multivariate analysis adjusted for factors that influenced CAC progression, therapy with sodium thiosulfate was an independent protective factor (odds ratio = 0.05, P = 0.04). Major side effects were persistent anorexia and metabolic acidosis.
The effect of sodium thiosulfate in delaying the progression of CAC is encouraging and will require a larger study. Determination of the safe therapeutic window is necessary in order to avoid bone demineralization.
冠状动脉钙化（CAC）在血液透析患者中很常见，并预测心血管死亡率。除了改变传统的心血管危险因素外，还提倡针对降低血清磷酸盐和钙磷乘积的治疗。硫代硫酸钠通过其螯合特性，从沉淀的矿物质中去除钙，从而减少钙性尿毒症性小动脉病和软组织钙化的钙化负担。硫代硫酸钠对血液透析患者 CAC 的影响从未被研究过。
87 例稳定的慢性血液透析患者接受多层螺旋 CT 和骨密度（BMD）测量。纳入 CAC 评分≥300 的患者，在血液透析后每周两次静脉输注硫代硫酸钠，持续 4 个月。在治疗疗程结束时重新评估 CAC 和 BMD。
治疗组和对照组中分别有 25%和 63%的患者 CAC 进展（P=0.03）。治疗组 CAC 评分无变化，但对照组明显增加。治疗组全髋 BMD 明显下降。在调整影响 CAC 进展的因素的多变量分析中，硫代硫酸钠治疗是一个独立的保护因素（比值比=0.05，P=0.04）。主要副作用是持续厌食和代谢性酸中毒。
硫代硫酸钠延迟 CAC 进展的效果令人鼓舞，需要更大的研究。为了避免骨质脱矿，确定安全的治疗窗是必要的。
