Sodium thiosulfate … the grey area med that some centres fully embrace or avoids entirely due to the lack of randomized data. At our centre in Windsor, we had a couple nephrologists skeptical of the evidence and a couple others either very agreeable or willing to give it a try.
In the past year, we have had 3 patients use it with mixed results. I think most of the literature will recommend a 25 g IV dose given three times a week for a duration of 3 months (or at least what ODB EAP will cover). I have applied for thiosulfate via NIHB (you must use the Pfizer product DIN: 02137186) with a similar dose and length of prescription.
One of the limitations is how well the patient will tolerate it … it commonly causes nausea when infused (in our experience), but can be managed it with anti-emetics.
The results we have locally are confounded since we have our patients run from three times a week to six times a week for calciphylaxis. So did the increased dialysis frequency and/or the thiosulfate improve their calciphylaxis lesions?
I’m still not convinced it really works but then again, I haven’t seen some of the miraculous results as one of our nephrologists has personally witnessed when he was in his residency.