A Retrospective Analysis of Treatment of Wounds Caused by Calciphylaxis: Hyperbaric Oxygen Therapy with and Without Sodium Thiosulfate

Background. Calciphylaxis, or calcific uremic arteriolopathy, is a rare, devastating condition with a mortality approaching 80%, most often seen in patients with chronic kidney disease. It is characterized by calcification and intimal fibrosis with arteriolar stenosis and subsequent thrombosis. Skin changes such as livedo reticularis, tender papules, and violaceous plaques result and progress to necrotic ulceration. Management of calciphylaxis includes maintenance of normal levels of calcium, phosphorus and parathyroid hormone, and optimization of hemodialysis and nutritional status. In this cohort, aggressive wound management coupled with hyperbaric oxygen therapy (HBOT) and sodium thiosulfate has achieved improvement in rates of healing for recalcitrant wounds associated with calciphylaxis but limited evidence for the efficacy of either treatment exists.

Objective. The authors conducted a retrospective analysis of 106 patients treated for calciphylaxis at a wound and hyperbaric center at an academic institution between 2000 and 2018 who were considered for HBOT.

Materials and Methods. The authors assessed whether their response to therapy as measured by wound healing varied among patients who received sodium thiosulfate, hyperbaric oxygen treatment, both, or neither therapy. 

Results. Results showed HBOT to be beneficial in healing compared with no therapy at 91.2% (52/57) of patients with complete or substantial resolution of their wounds versus neither therapy at 8% (2/25) of patients. Sodium thiosulfate was found to be beneficial in healing compared with neither therapy (75%, 3/4 patients with complete or substantial resolution of their wounds vs. no therapy). In addition, combined HBOT and sodium thiosulfate was more beneficial in healing compared with either therapy alone and to neither therapy (85%, 17/20 patients with complete or substantial resolution of wounds.  

Conclusions. Given the dramatic clinical improvement, the authors feel that HBOT in combination with sodium thiosulfate may have an important adjunctive role in the treatment of calciphylaxis.

Citation: Armour DJ, Tailor Y, Preston-Hsu E. A retrospective analysis of treatment of wounds caused by calciphylaxis: hyperbaric oxygen therapy with and without sodium thiosulfate. Poster presented at: Symposium on Advanced Wound Care Spring; May 7-11, 2019; San Antonio, TX.

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This abstract was not subject to the WOUNDS^® peer-review process.

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