MO023EFFECTS OF SODIUM THIOSULFATE ON VASCULAR CALCIFICATIONS IN HEMODIALYSIS PATIENTS: A INTERVENTIONAL DOUBLE BLINDED RANDOMISED PLACEBO CONTROLED STUDY

Abstract

INTRODUCTION AND AIMS: Vascular calcification is a well recognized risk factor for cardiovascular events and mortality in hemodialysis (HD) population. Although a lot is known about its pathogenesis and outcome, there is little data on the treatment of established extraosseous calcification. The aim of the present study was to determine the effect of sodium thiosulfate (STS) given over 6 months on the progression of cardiovascular calcification in HD patients. METHODS: The study included 65 chronic HD patients who undrewent: MSCT of the abdominal aorta to determine calcification (Agatson score, AACS), pulse wave velocity (PWV), heart ultrasound and ultrasound of carotid arteries (CCA). Those with AACS> 100 (n=60) were randomised to receive either STS (n=30) over a period of six months during the last 30 minutes of every HD session (25g/1,73 m2), while 30 patiens received placebo (saline). 56 patients finished the study and the effect of therapy was analyzed by repeated diagnostic tests for cardiovascuar calcifications. RESULTS: There were no differences in baseline parameters between the two groups. Serum phosphate increased significantly after six months of therapy with STS but not placebo; no other major differences between the two treatments occurred, serum calcium significantly decreased, and iPTH increased in both groups but w/o statistical significance. In both groups AACS and calcification volume scores in the abdominal aorta significantly increased after six months of therapy (Table 1). PWV and IMT significantly decreased in the STS group but not in the placebo group. All cardiac parameters (left ventricle end‐diastolic diameter (LVEDD), left ventricle end systolic diameter (LVDES), ventricular septum thickness in diastole (IVDS), left ventricle posterior wall thickness in diastole (LPWD)) significantly deteriorated in the placebo group (Table 1), but not the interventional group. Also, there were no new calcified valves in the interventional group, while in the control group 8 new calcified valves appeared (p<0.001). During the treatment period, there were no adverse events related to the applied therapy. CONCLUSIONS: STS may slow the progression of valvular calcifications and arterial stiffness. Decreased PWV may translate into a slower progression of LVH among the patients treated with STS. STS proved to be safe therapy during the period of 6 months.