Successfully Treated Calcific Uremic Arteriolopathy: Two Cases of a High Anion Gap Metabolic Acidosis with Intravenous Sodium Thiosulfate

Table 1

Cases of calcific uremic arteriolopathy with an anion gap metabolic acidosis from sodium thiosulfate.

	Patient characteristics	Dose	Duration	Laboratory values	Outcome
Cicone et al.; 2004 [2]	69-year-old Caucasian female with ESRD on CAPD for 4 months.	25 g IV 3x/week	8 months	Average HCO3 = 15.4 mmol/L; Average AG = 26.1 mmol/L	Resolution of pain and reduction in size of subcutaneous plaques.
Selk and Rodby; 2011 [3]	65-year old female with ESRD on HD.	25 g IV 3x/week after HD	Not specified	HCO3 = 10 mmol/L; AG = 44 mmol/L	Acidemia prompted a significant reduction in STS dose. CUA outcome not specified.
Brucculeri et al.; 2005 [4]	48-year-old Caucasian female with ESRD on HD.	5 g IV 4x/week after HD	34 months at time of publication.	Average HCO3 = 13.1 mmol/L; Average AG = 26.7 mmol/L	Excellent wound healing without disease recurrence.
Vanparys et al.; 2013 [5]	71-year-old Caucasian female status, after cadaveric renal transplant with CKD 4 secondary to cyclosporine toxicity and chronic allograft dysfunction.	12.5 g IV BID	2 weeks	HCO3 = 12 mmol/L; AG not specified	STS dose decreased to 7.5 g BID and PO bicarbonate started. Patient showed improved wound healing but died from sepsis.
Mao et al.; 2013 [6]	71-year-old Caucasian female with CKD 4.	25 g IV daily	2 weeks	Serum pH <6.80; HCO3 = 6 mmol/L; AG = 45 mmol/L	Survived 2 cardiac arrests. Patient declined further treatment and was discharged to hospice.
Rein et al. (this report)	49-year-old Caucasian female with ESRD on CAPD.	25 g IV daily	5 months	HCO3 = 8 mmol/L,; AG = 50 mmol/L	Dose changed to 12.5 mg IV every other day then 12.5 mg weekly. Cured of calciphylaxis in 5 months.
	51-year-old Caucasian male with ESRD started on HD.	25 g IV 3x/week after HD	4 months	HCO3 = 18 mmol/L,; AG = 27 mmol/L	No change in STS dose. Cured of calciphylaxis in 4 months.