CARDIOVASCULAR JOURNAL OF AFRICA • Volume 35, No 2, May – August 2024 AFRICA 117 mean difference (SMD) and 95% confidence intervals (CI) for the continuous index. A p-value less than 0.05 represented statistical significance. While there were established outcomes from two or more studies, meta-analysis was applied. Statistical heterogeneity in addition to trials was investigated using the I² test and p-values. Table 1. Main characteristics of the eight included studies: STS treatment on vascular calcificition in dialysis patients Author, year Country Study design Population Intervention Comparator Combination therapy Primary outcome Secondary outcome(s) Adverse events Adirekkiat,29 2010 Thailand Non-RCT ESRD on HD with CACs ≥ 300 STS 12.5 g IV over 15–20 min after HD, 2/ week, duration 4 months (n = 16) Control group (n = 16) Phosphate binders (only calcium carbonate was used) and alfacalcitriol/ calcitriol No progression of CACs in STS group but significantly increased in control group Total hip BMD declined in STS group Anorexia and poor appetite in 75%, resulting in discontinuation in 10%. Sneezing in three patients (19%), two episodes of transient hypotension in two patients and one episode of dizziness. Messa,32 2014 Italy RCT ESRD on HD STS 5 g IV after HD, duration 3–12 months (n = 35) Control group (n = 37) – No effect on AC seems to be attributable to STS, at least when using a dose of 5 g per session Only DM patients, treated with STS, (n = 12) displayed a significant decrease of KS (KS –8.2 ± 6.6%; p = 0.03). – Yu,23 2016 China RCT ESRD on HD with CACs > 50 STS 0.18 g/kg IV in 30 min after HD, after each HD, duration 3 months (n = 15) Control group (n = 10) Phosphate binders (only calcium carbonate was used) and calcitriol CACs increased in control group while unchanged in STS group Significantly decreased hsCRP in STS group No mention of side effects Saengpanit,30 2018 Thailand RCT ESRD on HD with AS (CAVI ≥ 8) STS 12.5 g IV during last hour of HD, 2/ week, duration 6 months (n = 24) Control group (n = 26) Phosphate binders (only calcium carbonate was used) and calcitriol AS measured by CAVI significantly decreased in STS group while unchanged in control No progression in the natural logarithm of CAC volume score in STS group, while significantly increased in control group Anorexia and poor appetite in 12.5% of patients without discontinuation Djuric,22 2019 Serbia RCT ESRD on HD with AACs ≥ 100 STS 25 g/1.73 m2 IV during the last 15 min of HD, duration 6 months. (n = 26) Control group (n = 29) Phosphate binders (only calcium carbonate was used) and calcitriol Patients receiving STS exhibited a reduction of their IACS Reduced PWV and a lower carotid intima–media thickness and had better preservation of echocardiographic parameters of left ventricular hypertrophy No adverse events possibly related to STS infusion were noted Mao,27 2019 China RCT ESRD on PD with CACs ≥ 130 STS 12.8 g IV, 2/ week, duration 3 months (n = 15) Control group (n = 15) Calcitriol was used The CACs of control group were higher than those of before treatment and STS intervention group, there was no significant difference in CACs between STS group and before treatment Significantly decreased hsCRP in STS group Nausea and vomiting in 2 patients and thirst in 1 patient Li,34 2021 China RCT ESRD on HD with coronary artery calcification STS 0.18 g/kg IV in 30 min after HD, after each HD, duration 3 to 6 months (n = 30) Control group (n = 30) Phosphate binders (only calcium carbonate was used) and calcitriol The CACs score of the observation group decreased statistically significantly compared with the control group – No mention of side effects Bian,35 2021 China RCT ESRD on HD with coronary artery calcification STS 0.18 g/kg IV in 30 min after HD, after each HD, duration of 6 months (n = 25) Control group (n = 25) Phosphate binders (only calcium carbonate was used) and calcitriol The CAC score of the treatment group decreased significantly after treatment The proportion of skin pruritus, myasthenia, bone pain, insomnia and restless leg syndrome in the treatment group was significantly lower than those before treatment. Significantly decreased hsCRP in STS group No mention on side effects STS, sodium thiosulfate; BMD, bone mass density; CACs, coronary artery calcium score; IACS, iliac artery calcification score; PWV, pulse-wave velocity; VC, vascular calcification; AS, arterial stiffness; CAVI, cardio-ankle vascular index, ESRD, end-stage renal disease; g, gram; HD, haemodialysis, PD, peritoneal dialysis; hsCRP, highsensitivity C-reactive protein; IV, intravenous; min, minutes; iPTH, parathyroid hormone; OPG, osteoprotegerin; PINP, N-terminal propeptide of type I precollagen; MGP, matrix Gla protein; FGF23, fibroblast growth factor 23.
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