CARDIOVASCULAR JOURNAL OF AFRICA • Volume 35, No 2, May – August 2024 122 AFRICA 12.5 g three times weekly has been suggested.29,30 STS-induced metabolic acidosis might be solved by bicarbonate dialysate. Finally, the negative impact on bone integrity deserves further research.55 To the best of our knowledge, hypercalcaemia after treatment with intravenous STS has been described in only one study.56 This aspect is worthy of further study. The endpoints of the included studies seemed weak and lacked a comparison of death rates. Outcomes for intravenous STS in calciphylaxis are available. Treatment of uraemic calciphylaxis with systemic STS has been reported to have a significantly lower overall mortality rate than conventional treatment.56,57 However, a meta-analysis analysed the pooled mortality rate resulting from seven included cohort studies on the use of intravenous STS, which was not different in patients who received STS compared with the control group.58 Large-scale prospective studies are needed to validate the effect of sodium thiosulfate on long-term survival in dialysis patients. Limitations This study aimed to determine the effect of intravenous STS on vascular calcification, which is very meaningful and has clinical value. Unfortunately, only eight studies were included. This metaanalysis had several limitations that should be confirmed. First, the article has limitations primarily due to the quality of the studies and the size of the data. But we believe the article in its current version has useful information for clinicians and researchers. Second, vascular calcification is a slowly progressing process, and it takes a long time to observe the effect on the progression of vascular calcification. Due to the short duration (only three to 12 months) of the eight included studies, the long-term actions of intravenous STS treatment are still unclear. Finally, there is no information on whether the decrease in these scores is sustained after STS is stopped or whether the reduction affects outcomes. Conclusion This meta-analysis suggested that intravenous STS may be a promising agent to slow down vascular calcification and arterial stiffness in dialysis patients with end-stage renal disease. Given the low cost of STS and its acceptable rate of adverse effects, it should be considered when developing healthcare policies for dialysis patients. 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