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Review Article
Online Published: 28 Jan 2026
 


Evaluating the efficacy of sodium thiosulfate in the management of uremic calciphylaxis among patients with end-stage renal disease: a systematic review and meta-analysis

Yara Alorfi, Lojain Mazker Alsharif, Shahad Alshamrani, Dana Alamoudi, Muhannad Salem Alhamrani, Nawaf Alaklabi, Ebtisam Alhatimi, Mohamad Alqahtani, Mohanad Almaimani.


Abstract
Calciphylaxis remains a devastating condition, most commonly affecting patients with end-stage renal disease (ESRD) and carrying substantial morbidity and mortality. Sodium thiosulfate (STS) has been increasingly used as an off-label therapeutic option due to its potential chelating, vasodilatory, and wound-healing effects; however, the quality of supporting evidence remains limited. This review synthesized available data to better characterize the clinical effectiveness and safety of STS in uremic calciphylaxis. A systematic review and meta-analysis were conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Several databases were searched from inception to November 2025. Adult ESRD patients receiving systemic STS for confirmed calciphylaxis were eligible. Cohort studies and case series with ≥3 patients were included in the quantitative analysis; case reports were narratively summarized. Primary outcomes were clinical improvement of lesions and overall survival. Random-effects models were used to derive pooled proportions. A total of 17 studies (encompassing 87 patients) met the inclusion criteria. Five studies contributed data to the improvement analysis, yielding a pooled clinical response rate of 82.1% (95% CI, 0.706-0.917; I² = 0%). The pooled overall survival from five studies was 61.1% (95% CI, 0.23-0.93; I² = 86.7%). Case reports consistently described symptomatic relief, partial or complete wound healing, and generally favorable tolerance, although systematic reporting of adverse events remained limited. STS appears to offer meaningful clinical benefit for uremic calciphylaxis, with high rates of lesion improvement and acceptable short-term safety. Nevertheless, the evidence base remained constrained by small, heterogeneous studies, underscoring the need for prospective, standardized research.

Key words: Calciphylaxis, sodium thiosulfate, ESRD, dialysis, wound healing, systematic review


 
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How to Cite this Article
Pubmed Style

Alorfi Y, Alsharif LM, Alshamrani S, Alamoudi D, Alhamrani MS, Alaklabi N, Alhatimi E, Alqahtani M, Almaimani M. Evaluating the efficacy of sodium thiosulfate in the management of uremic calciphylaxis among patients with end-stage renal disease: a systematic review and meta-analysis. IJMDC. 2026; 10(2): 816-824. doi:10.24911/IJMDC.51-1768157100

Web Style

Alorfi Y, Alsharif LM, Alshamrani S, Alamoudi D, Alhamrani MS, Alaklabi N, Alhatimi E, Alqahtani M, Almaimani M. Evaluating the efficacy of sodium thiosulfate in the management of uremic calciphylaxis among patients with end-stage renal disease: a systematic review and meta-analysis. https://www.ijmdc.com/?mno=306424 [Access: June 27, 2026]. doi:10.24911/IJMDC.51-1768157100

AMA (American Medical Association) Style

Alorfi Y, Alsharif LM, Alshamrani S, Alamoudi D, Alhamrani MS, Alaklabi N, Alhatimi E, Alqahtani M, Almaimani M. Evaluating the efficacy of sodium thiosulfate in the management of uremic calciphylaxis among patients with end-stage renal disease: a systematic review and meta-analysis. IJMDC. 2026; 10(2): 816-824. doi:10.24911/IJMDC.51-1768157100


Vancouver/ICMJE Style

Alorfi Y, Alsharif LM, Alshamrani S, Alamoudi D, Alhamrani MS, Alaklabi N, Alhatimi E, Alqahtani M, Almaimani M. Evaluating the efficacy of sodium thiosulfate in the management of uremic calciphylaxis among patients with end-stage renal disease: a systematic review and meta-analysis. IJMDC. (2026), [cited June 27, 2026]; 10(2): 816-824. doi:10.24911/IJMDC.51-1768157100


Harvard Style

Alorfi, Y., Alsharif, . L. M., Alshamrani, . S., Alamoudi, . D., Alhamrani, . M. S., Alaklabi, . N., Alhatimi, . E., Alqahtani, . M. & Almaimani, . M. (2026) Evaluating the efficacy of sodium thiosulfate in the management of uremic calciphylaxis among patients with end-stage renal disease: a systematic review and meta-analysis. IJMDC, 10 (2), 816-824. doi:10.24911/IJMDC.51-1768157100


Turabian Style

Alorfi, Yara, Lojain Mazker Alsharif, Shahad Alshamrani, Dana Alamoudi, Muhannad Salem Alhamrani, Nawaf Alaklabi, Ebtisam Alhatimi, Mohamad Alqahtani, and Mohanad Almaimani. 2026. Evaluating the efficacy of sodium thiosulfate in the management of uremic calciphylaxis among patients with end-stage renal disease: a systematic review and meta-analysis. International Journal of Medicine in Developing Countries, 10 (2), 816-824. doi:10.24911/IJMDC.51-1768157100


Chicago Style

Alorfi, Yara, Lojain Mazker Alsharif, Shahad Alshamrani, Dana Alamoudi, Muhannad Salem Alhamrani, Nawaf Alaklabi, Ebtisam Alhatimi, Mohamad Alqahtani, and Mohanad Almaimani. "Evaluating the efficacy of sodium thiosulfate in the management of uremic calciphylaxis among patients with end-stage renal disease: a systematic review and meta-analysis." International Journal of Medicine in Developing Countries 10 (2026), 816-824. doi:10.24911/IJMDC.51-1768157100


MLA (The Modern Language Association) Style

Alorfi, Yara, Lojain Mazker Alsharif, Shahad Alshamrani, Dana Alamoudi, Muhannad Salem Alhamrani, Nawaf Alaklabi, Ebtisam Alhatimi, Mohamad Alqahtani, and Mohanad Almaimani. "Evaluating the efficacy of sodium thiosulfate in the management of uremic calciphylaxis among patients with end-stage renal disease: a systematic review and meta-analysis." International Journal of Medicine in Developing Countries 10.2 (2026), 816-824. Print. doi:10.24911/IJMDC.51-1768157100


APA (American Psychological Association) Style

Alorfi, Y., Alsharif, . L. M., Alshamrani, . S., Alamoudi, . D., Alhamrani, . M. S., Alaklabi, . N., Alhatimi, . E., Alqahtani, . M. & Almaimani, . M. (2026) Evaluating the efficacy of sodium thiosulfate in the management of uremic calciphylaxis among patients with end-stage renal disease: a systematic review and meta-analysis. International Journal of Medicine in Developing Countries, 10 (2), 816-824. doi:10.24911/IJMDC.51-1768157100




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