Intravenous sodium thiosulfate (STS) may slow the progression of vascular calcification and arterial stiffness in patients on hemodialysis, a new study finds.

Investigators performed a systematic review and meta-analysis of 6 studies involving 305 patients (mean age: 56 years; 56.6% male) receiving maintenance hemodialysis. The progression in vascular calcification, measured by Agatston score, was lower at the coronary arteries and iliac arteries among STS-treated patients compared with patients receiving usual care (mean differences -241.27 and -382.00, respectively), Wen Wen, MD, PhD, of Massachusetts General Hospital, Boston, Massachusetts, and colleagues reported in Nephrology Dialysis Transplantation. No difference was found at the aorta, “suggesting that diverse mechanisms might be involved.” The increase in arterial stiffness, measured by pulse wave velocity, was also lower in the STS group (mean difference -1.29 m/s).

For safety, the investigators assessed adverse symptoms, chronic kidney disease-mineral and bone disorder (CKD-MBD) parameters, electrolytes, and bone mineral density. A proportion of SPS users experienced gastrointestinal symptoms (25.9%), hypotension (4.7%), sneezing (4.7%), flushing (2.3%), dizziness (2.3%), and thirst (1.2%). During the trial period, investigators reported a higher anion gap and a greater increase in the anion gap in the STS group.

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Calcium, phosphate, and intact parathyroid hormone levels did not change significantly during the trial period and were comparable between the STS and the control group. The mean level of 25-hydroxyvitamin D3 did not change from baseline but was a mean 5.80 ng/mL lower in the STS group. STS treatment did not reduce bone mineral density.

“Future large and well-designed randomized controlled trials are warranted to further establish the effect of STS,” according to Dr Wen’s team.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Wen W, Portales-Castillo I, Seethapathy R, et al. Intravenous sodium thiosulphate for vascular calcification of hemodialysis patients – a systematic review and meta-analysis. Nephrol Dial Transplant. Published online May 6, 2022. doi:10.1093/ndt/gfac171