CARDIOVASCULAR JOURNAL OF AFRICA • Volume 35, No 2, May – August 2024 AFRICA 115 Systematic Review Effects of intravenous sodium thiosulfate on vascular calcification in dialysis patients with end-stage renal disease: a systematic review and meta-analysis Yu-Huan Song, AiBing Ning, Na Guo, Ying Yang, Fei Tang, Na Zhao, Jun Hu, Hong Wu, Ting Peng, Yue-fei Xiao, Guang-Yan Cai Abstract Background: In dialysis patients, vascular calcification is a common complication and is closely related to the morbidity and mortality of cardiovascular disease. We performed a systematic review to determine the efficacy and safety of sodium thiosulfate (STS) in the progression of vascular calcification in dialysis patients with end-stage renal disease. Methods: The PubMed, Web of Science, Embase, Cochrane Library, Wanfang, CNKI, China Biology Medicine disc and Weipu databases were searched up to 9 March 2022 for clinical trials to synthesise findings on the efficacy and safety of STS in the progression of vascular calcification in dialysis patients. The primary outcome was coronary artery calcification scores (CACS) or abdominal aortic calcification scores (AACS) or Kauppila index. The secondary outcome was pulse-wave velocity (PWV). Laboratory data were shown in safety data. A random-effect model was used to provide the summary measures of effect [standardised mean difference (SMD) and 95% confidence interval (CI)]. Results: Seven randomised, controlled trials and one nonrandomised, controlled trial involving 370 patients were included. Six studies reported that the progression of CACS or AACS was slower in the intravenous STS group compared with the control group (SMD –3.24, 95% CI: –5.29, –1.18, p = 0.002). Two studies showed the increase in PWV was less in the STS group compared with the control group (SMD –0.52, 95% CI: –0.92, –0.13, p = 0.009). During the trial period, a lower high-sensitivity C-reactive protein level (SMD1.61, 95% CI: 0.19, 3.04, p = 0.03), a decrease in serum bicarbonate level (SMD0.67, 95% CI: 0.22, 1.11, p = 0.003) and an increase in serum phosphate level (SMD–0.32, 95% CI: –0.62, –0.03, p = 0.03) were noted in the intravenous STS group compared with the control group. However, serum calcium and parathyroid hormone levels showed no difference between the two groups after the trials. The most common adverse events were temporary nausea and vomiting, which occurred in 12.5 to 75% of patients. Conclusions: Intravenous STS may slow down the progression of vascular calcification and ameliorate arterial stiffness in dialysis patients. Reliably defining the efficacy and safety of intravenous STS in attenuating the progression of vascular calcification requires a high-quality trial with a large sample size. Keywords: sodium thiosulfate, dialysis, vascular calcification Submitted 10/3/22; accepted 12/4/23 Published online 3/7/23 Cardiovasc J Afr 2024; 35: 115–123 www.cvja.co.za DOI: 10.5830/CVJA-2023-020 Vascular calcification and arterial stiffness are strong risk factors for cardiovascular disease. They contribute to high morbidity and mortality rates in dialysis patients.1,2 Coronary artery calcification is an agent of coronary atherosclerosis and is associated with adverse cardiovascular events. Coronary artery calcification can be calculated by chest computerised tomography (CT) and measured by the Agatston score.3 This is a confirmed method for measuring atherosclerotic plaque load and is capable of providing non-invasive quantitative information on the coronary artery vessels. There is a dearth of treatment that can reverse or stabilise the progression of vascular calcification.4 Statin therapy in dialysis patients as preventative therapy has not been shown to Department of Nephrology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China Yu-Huan Song, PhD Na Guo, MD Ying Yang, MD Fei Tang, MD Na Zhao, MD Jun Hu, MD Hong Wu, MD Yue-fei Xiao, MD Department of Library, Gansa Medical College, Pingliang, Gansu, China AiBing Ning, MD, 64807184@qq.com Department of Nephrology, State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital, Beijing, China Guang-Yan Cai, MD, caiguangyan@sina.com Centre for Natural Products Research, Chengdu Institute of Biology, Chinese Academy of Sciences, Chengdu, China Ting Peng, MD
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