Efficacy and its predictor in microwave ablation for severe secondary hyperparathyroidism in patients undergoing haemodialysis

Diao, Zongli; Liu, Xu; Qian, Linxue; Liu, Jing; Liu, Sha; Liu, Wenhu

doi:10.1080/02656736.2016.1194485

Cited by 15 publications

(24 citation statements)

References 32 publications

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“…Compared to other kinds of thermal ablation, such as radiofrequency ablation and laser ablation, MWA has several advantages including a more predictable ablation zone, ability to simultaneously treat multiple lesions, large ablation volumes, and fast ablation times . To compare the efficacy of MWA and parathyroidectomy for SHPT, Diao et al conducted a study in 30 patients undergoing maintenance hemodialysis and concluded that parathyroidectomy was more effective for severe SHPT than MWA . However, our study, with a larger sample size of 81 cases, showed that MWA was more effective for severe SHPT than parathyroidectomy.…”

Section: Discussioncontrasting

confidence: 59%

“…Diao et al also demonstrated that baseline iPTH level was an independent predictor of MWA efficacy for severe SHPT, and a threshold value of 1493.7 pg/ml yielded higher sensitivity and specificity . However, the OR value of 0.997 (95% CI, 0.994–0.999) in that study was very close to the critical point.…”

Section: Discussionmentioning

confidence: 77%

“…As a minimally invasive form of treatment, thermal ablation, such as microwave ablation and radiofrequency ablation, has been increasingly used to treat SHPT . 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) . However, the efficacy and safety of MWA for refractory secondary SHPT is not conclusive.…”

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: Discussioncontrasting

confidence: 59%

Section: Discussionmentioning

confidence: 77%

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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“…The studies covered a period !8 years, from 2009 to 2017. Two were retrospective cohort studies [26,27], and six were retrospective self-control studies [28][29][30][31][32][33]. The mean follow-up period ranged from six to 23 months, and the sample size ranged from 9-56 patients.…”

Section: Discussionmentioning

confidence: 99%

“…The phosphorus measurements obtained one day after MWA were significantly lower than those obtained before MWA (WMD: 0.289, 95% CI: 0.163-0.415, p < 0.01) (Figure 4(A)). Four articles reported phosphorus measurements obtained at one week [26,27,29,30] and one month [26,27,29,31], respectively, after MWA. The heterogeneity among studies was significant, so the random-effects model was used for the analysis (p < 0.01, I 2 ¼ 86.5%; p < 0.01, I 2 ¼ 85.3%).…”

Section: The Change Of Phosphorusmentioning

confidence: 99%

Efficacy and safety of microwave ablation treatment for secondary hyperparathyroidism: systematic review and meta-analysis

Cao

Zhao

Wei

et al. 2020

International Journal of Hyperthermia

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Purpose: The present systematic review and meta-analysis was designed to evaluate the efficacy and safety of microwave ablation (MWA) treatment for secondary hyperparathyroidism (SHPT). Materials and methods: The study authors systematically searched the Web of Science, Cochrane Library, PubMed, Embase and Ovid databases for studies published in English prior to 7October 2019. All studies included in the meta-analysis measured levels of parathyroid hormone (PTH), calcium and phosphorus, and included data related to complications following MWA treatment for SHPT. Results: The meta-analysis ultimately included 233 patients from two retrospective cohort studies and six retrospective self-control studies. Compared to PTH level measurements obtained after MWA, measurements obtained at one day (weighted mean differences (WMD): 890.314, 95% confidence interval (CI): 767.121-1013.506, p < 0.01) , one week (WMD: 860.298, 95% CI: 759.401-961.194, p < 0.01), one month (WMD: 800.846, 95% CI: 687.709-913.983, p < 0.01) and six months (WMD: 860.847, 95% CI: 745.214-976.480, p < 0.01) after MWA were significantly lower. Calcium and phosphorus levels at one day and one week after MWA were also significantly lower than those measured before MWA. After MWA, the incidence of nerve injury was 1.2% (3/233; effect size (ES): 0.022, 95% CI: À0.003-0.048, p < 0.01). After MWA, the incidence of hypocalcemia was 15.8% (37/233; ES: 0.449, 95% CI: 0.341-0.556, p < 0.01). Conclusion: The preliminary results of this meta-analysis indicate that MWA may be effective and safe in treating patients with SHPT, and that future prospective research and randomized controlled trials (RCT) are necessary.

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Thermal ablation versus parathyroidectomy for secondary hyperparathyroidism: A meta-analysis

Gong¹,

Tang²,

Lu³

et al. 2019

International Journal of Surgery

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Efficacy and its predictor in microwave ablation for severe secondary hyperparathyroidism in patients undergoing haemodialysis

Abstract: Baseline iPTH level is a good predictor of MWA efficacy for severe secondary hyperparathyroidism; parathyroidectomy is more effective for severe secondary hyperparathyroidism than MWA.

Cited by 15 publications

References 32 publications

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

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

Efficacy and safety of microwave ablation treatment for secondary hyperparathyroidism: systematic review and meta-analysis

Thermal ablation versus parathyroidectomy for secondary hyperparathyroidism: A meta-analysis

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