Possibly enhanced Gd excretion in dialysate, but no major clinical benefit of 3–5 months of treatment with sodium thiosulfate in late stages of nephrogenic systemic fibrosis

• Published in: Nephrology, dialysis, transplantation dialysis, transplantation, 2008-10, Vol.23 (10), p.3280-3282
• Main Authors: Marckmann, Peter, Nielsen, Arne Høj, Sloth, Jens Jørgen
• Format: Article
• Language: English
• Subjects: Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Chelating Agents - therapeutic use; Contrast Media - adverse effects; Contrast Media - pharmacokinetics; Emergency and intensive care: renal failure. Dialysis management; Female; gadodiamide; gadolinium; Gadolinium - adverse effects; Gadolinium - pharmacokinetics; Gadolinium DTPA - adverse effects; Gadolinium DTPA - pharmacokinetics; Hemodialysis Solutions - analysis; Humans; Intensive care medicine; Magnetic Resonance Imaging - adverse effects; Medical sciences; Middle Aged; Nephrogenic Fibrosing Dermopathy - drug therapy; Nephrogenic Fibrosing Dermopathy - etiology; Nephrogenic Fibrosing Dermopathy - metabolism; Nephrogenic Fibrosing Dermopathy - prevention & control; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Renal Dialysis; Renal failure; Renal Insufficiency - diagnosis; Thiosulfates - therapeutic use; Time Factors
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfn217

Background. Gd-related nephrogenic systemic fibrosis was successfully treated with intravenous sodium thiosulfate according to a recent case report. Methods. Four haemodialysis patients with severe Gd-related nephrogenic systemic fibrosis were treated with intravenous sodium thiosulfate for 3–5 months. Symptoms and patients’ experiences were investigated. The dialysate Gd content was monitored. Results. We observed no major clinical improvements in any patient. In one patient, we found slightly improved joint motion. Two patients had a subjective impression of slight improvements of joint motion and skin abnormalities. The dialysate Gd content was raised by the treatment, up to fivefold. Conclusions. We could not confirm that sodium thiosulfate treatment results in marked and rapid improvement in late stages of Gd-related nephrogenic systemic fibrosis. However, dialysate contents of Gd seemed to increase. It is unknown whether increased Gd excretion will lead to long-term clinical improvements in late stages of nephrogenic systemic fibrosis.