Department of Nephrology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
Nephrol Dial Transplant. 2023 Feb 28;38(3):733-745. doi: 10.1093/ndt/gfac171.
Vascular calcification (VC) is a common comorbidity among patients with chronic kidney disease (CKD), indicating major cardiovascular events. This study aimed to evaluate the effects and safety of intravenous sodium thiosulphate (STS) for VC in CKD patients.
Electronic databases were searched for clinical trials that provided data comparing outcomes among patients treated with and without STS. The PRISMA guidelines were followed. Efficacy was assessed using calcification scores and arterial stiffness. Safety was examined by analyzing adverse symptoms, electrolytes and bone mineral density (BMD). Random-effects models were performed. Meta-regression and sensitivity analysis were done. The risk of bias was assessed using the Cochrane tools.
Among the 5601 publications, 6 studies involving 305 participants (mean age: 56 years, male: 56.6%) with all participants on maintenance hemodialysis met eligibility criteria. For efficacy, the progression in Agatston scores in the coronary arteries [107 patients, mean difference (MD): -241.27, 95% confidence interval (95% CI): -421.50 to -61.03] and iliac arteries (55 patients, MD: -382.00, 95% CI: -751.07 to -12.93) was lower in the STS treated group compared with controls. The increase in pulse wave velocity was lower in the STS group (104 patients, MD: -1.29 m/s, 95% CI: -2.24 to -0.34 m/s). No association was found between the change in calcification scores and STS regimen. For safety, gastrointestinal symptoms (e.g. nausea) and increased anion gap acidosis were noted. No reduction in BMD by STS was observed.
Intravenous STS may attenuate the progression of VC and arterial stiffness in hemodialysis patients. Large and well-designed randomized controlled trials are warranted.
血管钙化（VC）是慢性肾脏病（CKD）患者的常见合并症，表明存在主要心血管事件。本研究旨在评估静脉注射硫代硫酸钠（STS）对 CKD 患者 VC 的疗效和安全性。
电子数据库检索提供 STS 治疗与未治疗患者结局比较数据的临床试验。遵循 PRISMA 指南。使用钙化评分和动脉僵硬度评估疗效。通过分析不良反应、电解质和骨矿物质密度（BMD）来评估安全性。采用随机效应模型进行分析。进行了元回归和敏感性分析。使用 Cochrane 工具评估偏倚风险。
在 5601 篇文献中，有 6 项研究涉及 305 名参与者（平均年龄：56 岁，男性：56.6%），所有参与者均接受维持性血液透析，符合入选标准。在疗效方面，STS 治疗组与对照组相比，冠状动脉（107 例患者，平均差异（MD）：-241.27，95%置信区间（95%CI）：-421.50 至-61.03）和髂动脉（55 例患者，MD：-382.00，95%CI：-751.07 至-12.93）的 Agatston 评分进展较低。STS 组脉搏波速度的增加较低（104 例患者，MD：-1.29 m/s，95%CI：-2.24 至-0.34 m/s）。STS 方案与钙化评分变化之间未发现关联。关于安全性，观察到胃肠道症状（如恶心）和阴离子间隙酸中毒增加。未观察到 STS 引起的 BMD 降低。
静脉注射 STS 可能会减轻血液透析患者 VC 和动脉僵硬度的进展。需要进行大型和精心设计的随机对照试验。
