Clinical efficacy and safety of sodium thiosulfate in the treatment of uremic pruritus: a meta-analysis of randomized controlled trials.

Uremic pruritus (UP) is a debilitating condition frequently associated with chronic kidney disease, severely impairing patients' quality of life and contributing to increased mortality. Recent studies have suggested that intravenous sodium thiosulfate (STS) may offer therapeutic relief for pruritus in patients undergoing hemodialysis. To assess its effectiveness, we conducted a systematic review and meta-analysis to explore the potential of intravenous STS in managing UP. A comprehensive search of electronic databases was performed up to September 2024 to identify randomized controlled trials evaluating the clinical efficacy of STS in treating UP. Eight studies, encompassing 520 participants, were included in the analysis. The findings indicated that the STS group achieved a significantly higher rate of pruritus suppression compared to control groups. The STS group showed a marked reduction in the Visual Analogue Scale (weighted mean difference = -5.023; 95% CI: -6.137 to -3.909; P < 0.001) and Pittsburgh Sleep Quality Index (weighted mean difference = -4.754; 95% CI: -5.432 to -4.075; P < 0.001). The STS group demonstrated a decrease in CRP levels compared to the non-treatment group in the context of treating UP (WMD = -1.269; 95% CI: -2.014 to -0.523; P = 0.007). No significant differences were observed between the STS and control groups regarding parathyroid hormone, serum calcium, or serum inorganic phosphorus. While this meta-analysis demonstrated a reduction in pruritus symptoms with STS administration, the evidence remains insufficient to conclusively support its therapeutic benefit in managing UP. Further well-designed studies with larger sample sizes are needed to confirm these findings.