Advances and controversies in the mechanism of sodium thiosulfate for vascular calcification of calciphylaxis

As a special vascular calcification in patients with end-stage renal disease, calciphylaxis has atypical early clinical symptoms, a poor prognosis and unclear clinical guidelines. Currently sodium thiosulfate(STS) has been a standard agent in the treatment of calciphylaxi. It acts mostly through the mechanisms of calcium chelation, antioxidant stress, acidosis, vasodilation, anti-inflammatory, analgesia and calcification inhibiton. However, there are still some ongoing controversies about these therapeutic mechanisms.