Effect of Hybrid Blood Purification Treatment on Secondary Hyperparathyroidism for Maintenance Hemodialysis Patients

Gao, Xueren; Li, Jiandong; Guo, Li; Guo, Shanshan; Zhang, Ran; Gou, Yanli; Chen, Hang

doi:10.1159/000486844

Cited by 4 publications

(4 citation statements)

References 13 publications

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“…Secondary hyperparathyroidism (SHPT), inducing a series of clinical symptoms such as high parathyroid hormone, disorders of calcium‐phosphorus metabolism, parathyroid hyperplasia, renal osteodystrophy, and cardiovascular calcification, is one of the main complications of end‐stage renal disease requiring dialysis therapy which is associated with increased mortality and decreased life quality . Administration of vitamin D and its analogues is the classical treatment for early SHPT, whereas parathyroidectomy is the standard therapy for severe drug‐resistant SHPT . As a minimally invasive form of treatment, thermal ablation, such as microwave ablation and radiofrequency ablation, has been increasingly used to treat SHPT .…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4] Administration of vitamin D and its analogues is the classical treatment for early SHPT, whereas parathyroidectomy is the standard therapy for severe drug-resistant SHPT. [5][6][7][8] As a minimally invasive form of treatment, thermal ablation, such as microwave ablation and radiofrequency ablation, has been increasingly used to treat SHPT. [9][10][11] Compared with parathyroidectomy, microwave ablation (MWA) offers more advantages including repeated ablation of SHPT in case of recurrence and preserved residual parathyroid tissue to prevent a permanent reduction in levels of intact parathyroid hormone (iPTH).…”

Section: Introductionmentioning

confidence: 99%

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Microwave ablation vs. parathyroidectomy for secondary hyperparathyroidism in maintenance hemodialysis patients

Jiang

Wang

Yao

et al. 2019

Hemodialysis International

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Introduction: Secondary hyperparathyroidism (SHPT) is a serious and common problem in patients undergoing maintenance hemodialysis. Minimally invasive microwave ablation (MWA) has been used to treat SHPT and shows some advantages. However, its efficacy is still undefined. The primary purpose of this study was to determine the efficacy and safety of MWA compared to total parathyroidectomy plus forearm autotransplantation. Methods: The SHPT patients who were undergoing maintenance hemodialysis (follow‐up for 6 to 24 months after treatments) were divided into a MWA group (n = 33) and a parathyroidectomy group (n = 48). The efficacy (serum intact parathyroid hormone [iPTH], calcium, and phosphorus levels) and safety (hoarseness, hypocalcaemia, and persistently low iPTH) were compared between the two groups. Additionally, the study explored potential predictors of response to MWA by a logistic regression analysis. Findings: There were no significant differences in baseline characteristics between the two groups. The rates of achieving the recommended goal for iPTH were significantly higher in the MWA group than that in the parathyroidectomy group at all follow‐up times: 57.58% vs. 12.50% at one‐day (P < 0.001), 45.45% vs. 16.67% at 1‐week (P = 0.005), 57.58% vs. 16.67% at 2‐week (P < 0.001), 57.58% vs. 22.92% at 1‐month (P = 0.002), and 69.70% vs. 35.42% at 3‐month (P = 0.002), 76.47% vs. 28.57% at 6‐month (P = 0.005), 87.50% vs. 47.37% at 12‐month (P = 0.008), and 81.82% vs. 52.63% at 24‐month (P = 0.015), respectively. However, there were no significant differences for phosphorus or calcium at any of the follow‐up times (P > 0.05). The persistently low iPTH was more in the parathyroidectomy group (64.6%) than that in the MWA group (0%) (P < 0.001), but there was no significant difference in hoarseness or hypocalcaemia (P > 0.05). Baseline levels of iPTH (P = 0.021) and patient age (P = 0.011) were determined as predictors by univariate logistic regression analysis. Conclusion: The MWA could be an alternative to parathyroidectomy for SHPT but its eventual superiority has to be demonstrated by a proper study.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Microwave ablation vs. parathyroidectomy for secondary hyperparathyroidism in maintenance hemodialysis patients

Jiang

Wang

Yao

et al. 2019

Hemodialysis International

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“…The results of our study once again confirmed that the combination of HD and HP reduced the manifestations related to calcium, phosphates, and PTH metabolic disorders and especially reduce the death rate due to cardiovascular events. A study of Gao et al [33] showed that iPTH, β2-M, and cystatin C (CysC) levels were significantly lower in the HD + HP group than in the HD group ( p < 0.05), and iPTH levels were significantly higher than those at the first day after treatment ( p < 0.05). Kaplan-Meier analysis of cardiovascular-related mortality was classified according to HD with and without HP (red line: HD group; violet line: HD + HP group).…”

Section: Discussionmentioning

confidence: 99%

A Combination of Hemodialysis with Hemoperfusion Helped to Reduce the Cardiovascular-Related Mortality Rate after a 3-Year Follow-Up: A Pilot Study in Vietnam

Huu¹,

Quy²,

Thu³

et al. 2020

Blood Purif

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Aims: Moderate to severe hyperparathyroidism (parathyroid hormone [PTH] concentrations ≥600 pg/mL) may increase the risk of cardiovascular problems and bone disease. We assume that a combination of hemodialysis with hemoperfusion may reduce the cardiovascular-related mortality rate in maintenance hemodialysis. Subjects and Methods: From 625 maintenance hemodialysis patients, 93 people met with our inclusion criteria. Based on the level of serum PTH, the patients were divided into 2 groups: 46 patients who underwent a combination of hemodialysis and hemoperfusion (HD + HP group) for consecutive 3 years and 47 patients who used hemodialysis only (HD group). Results: During 3 years of follow-up, the ratio of mortality was 4.3% in the HD + HP group which was significantly lower than in the HD group (17%), p = 0.049. Based on Kaplan-Meier analysis of cardiovascular-related mortality, patients in the HD group (red line) exhibited a significantly higher death rate compared to the HD + HP group (violet line) (log-rank test, p = 0.049). Conclusion: We demonstrated that a combination of hemodialysis and hemoperfusion for 3 years helped to reduce the cardiovascular-related mortality rate.

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“…Chromogranin A (CgA) is a very important endogenous cathepsin inhibitor which provides a dynamic equilibrium by regulating the production and degradation of extracellular vascular matrix [14]. An important mechanism involved in the development of ventricular remodeling in CHF patients is the imbalance in the ratio of cathepsin and endogenous protease inhibitors in extracellular matrix of cardiomyocytes [15].…”

Section: Discussionmentioning

confidence: 99%

Effect of serum cystatin C and chromogranin A on left ventricular mass index in patients with chronic heart failure

Xue¹,

Liu²

2019

Trop. J. Pharm Res

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Purpose: To investigate the expression of serum cystatin C (CystC) and chromogranin A (CgA) in chronic heart failure (CHF) patients, and their correlation with left ventricular mass index (LVMI). Methods: CHF patients (135) in the study hospital were randomly selected, and assigned to different groups on the basis of heart function grade (grades II to IV). Grades II, III and IV had 45 patients each. In addition, 45 people with normal physical examination results were assigned to the control group. In all patients, N-terminal natriuretic peptide (NT-proBNP), CysC and CgA were measured. In addition, left ventricular end-diastolic diameter (LVEDD), left ventricular end-diastolic volume (LVEDV), and left ventricular ejection fraction (LVEF) were measured using transthoracic echocardiography, and the results were used to calculate LVMI values. Results: There were significantly higher levels of CystC and CgA in CHF patients than in control patients (p < 0. 05). In grade IV patients, CystC and CgA levels were higher than the corresponding levels in patients with cardiac function grades II and III, while their levels in grade III patients were higher than in grade II patients (p < 0.05). The results of correlation analysis indicated that serum CgA was positively correlated with serum CystC. Serum CgA and CystC levels in CHF patients were negatively correlated with LVEF, but positively correlated with NT-proBNP and LVMI levels. Conclusion: Serum CgA and CysC are correlated with cardiac function grade and ventricular remodeling in CHF patients. Thus, to some extent, these two indices can be used to measure the degree of ventricular remodeling in CHF individuals.

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Effect of Hybrid Blood Purification Treatment on Secondary Hyperparathyroidism for Maintenance Hemodialysis Patients

Cited by 4 publications

References 13 publications

Microwave ablation vs. parathyroidectomy for secondary hyperparathyroidism in maintenance hemodialysis patients

Microwave ablation vs. parathyroidectomy for secondary hyperparathyroidism in maintenance hemodialysis patients

A Combination of Hemodialysis with Hemoperfusion Helped to Reduce the Cardiovascular-Related Mortality Rate after a 3-Year Follow-Up: A Pilot Study in Vietnam

Effect of serum cystatin C and chromogranin A on left ventricular mass index in patients with chronic heart failure

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