The Effectiveness And Safety Of Sodium Thiosulfate In The Treatment Of Vascular Calcification In Patients With End-stage Renal Disease: A Meta-Analysis

Background and Aim:Vascular calcification(VC)is common in patients with end-stage renal disease(ESRD)and has been shown to be an independent predictor of poor outcomes for cardiovascular events.With the increasing incidence of cardiovascular diseases in patients with ESRD,how to effectively delay VC has attracted our attention.At present,sodium thiosulfate(STS)is mainly used in the treatment of calciphylaxis abroad.In recent years,studies have proposed that it may delay the process of VC.In this study,literatures related to STS in the treatment of VC in ESRD patients were searched in Chinese and foreign databases for Meta-analysis,so as to provide evidence-based medicine reference for clinical treatment of VC.Methods:The Cochrane systematic evaluation method was used to search for PubMed,The Cochrane Library Database、Embase、Clinical Trials、The China biomedical database、CNKI 、Wip and Wanfang and other domestic and foreign Database websites.The retrieval time limit was from the establishment of each Database to December 2020,without any language restriction.The literatures related to STS in the treatment of VC in patients with ESRD were collected,and the literatures were screened according to the inclusion and exclusion criteria.The quality of the screened literatures was evaluated and the data were extracted.Meta-analysis was performed using Rev Man 5.4 and Stata 16.0 software.Results:Finally,we included 7 studies that met the requirements,involving a total of 337patients(169 in the STS group and 168 in the control group).Meta-analysis results showed that compared with the control group,the STS group significantly delayed the progression of Coronary artery calcification score(SMD=-0.43,95%CI[-0.76,-0.09],P=0.01);reduced Fibroblast growth factor 23(MD=-42.82,95%CI [-63.00,-22.63],P<0.0001);decreased C-reactive protein(MD=-1.37,95%CI[-2.36,-0.38],P=0.006);lowered Pulse wave velocity(MD=-1.24,95%CI[-2.25,-0.24],P=0.02);cutted serum bicarbonate(MD=-1.48,95%CI[-2.70,-0.25],P=0.02).However,STS treatment had no obvious effect on serum calcium(MD=0.06,95%CI[-0.02,0.14],P=0.13),serum phosphorus(MD=0.11,95%CI[-0.03,0.24],P=0.12),calcium-phosphorus product(MD=0.10,95%CI[-0.30,0.50],P=0.62)and intact parathyroid hormone(MD=-10.97,95%CI[-66.14,44.20],P=0.70).No significant adverse reactions were observed(RR=2.03,95%CI[0.86,4.77],P=0.11).Conclusion:In patients with end-stage renal disease,sodium thiosulfate can effectively alleviate the progression of vascular calcification,and no obvious adverse reactions have been observed.However,attention should be paid to the prevention of metabolic acidosis caused by the decrease of serum bicarbonate.