Abstract

Calciphylaxis remains a devastating condition, most commonly affecting patients with end-stage renal disease (ESRD) and carrying substantial morbidity and mortality. Sodium thiosulfate (STS) has been increasingly used as an off-label therapeutic option due to its potential chelating, vasodilatory, and wound-healing effects; however, the quality of supporting evidence remains limited. This review synthesized available data to better characterize the clinical effectiveness and safety of STS in uremic calciphylaxis. A systematic review and meta-analysis were conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Several databases were searched from inception to November 2025. Adult ESRD patients receiving systemic STS for confirmed calciphylaxis were eligible. Cohort studies and case series with ≥3 patients were included in the quantitative analysis; case reports were narratively summarized. Primary outcomes were clinical improvement of lesions and overall survival. Random-effects models were used to derive pooled proportions. A total of 17 studies (encompassing 87 patients) met the inclusion criteria. Five studies contributed data to the improvement analysis, yielding a pooled clinical response rate of 82.1% (95% CI, 0.706-0.917; I² = 0%). The pooled overall survival from five studies was 61.1% (95% CI, 0.23-0.93; I² = 86.7%). Case reports consistently described symptomatic relief, partial or complete wound healing, and generally favorable tolerance, although systematic reporting of adverse events remained limited. STS appears to offer meaningful clinical benefit for uremic calciphylaxis, with high rates of lesion improvement and acceptable short-term safety. Nevertheless, the evidence base remained constrained by small, heterogeneous studies, underscoring the need for prospective, standardized research.

Key words: Calciphylaxis, sodium thiosulfate, ESRD, dialysis, wound healing, systematic review