Efficacy of percutaneous ethanol injection therapy (PEIT) is related to the number of parathyroid glands in haemodialysis patients with secondary hyperparathyroidism

Koiwa, Fumihiko; Kakuta, Tsunekazu; Tanaka, Reika; Yumita, Shigeru

doi:10.1093/ndt/gfl620

Cited by 43 publications

(46 citation statements)

References 20 publications

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“…When overlooked during parathyroidectomy, the ectopic gland may cause persistent or recurrent hyperparathyroidism [107]. For patients who refuse or are not candidates for surgery, direct injection of ethanol [108] or active vitamin D into the parathyroid [109] may be considered, although long-term control of SHPT would be obtained only in patients with one enlarged gland [110].…”

Section: Treatment Of Shptmentioning

confidence: 99%

Diseases of the parathyroid gland in chronic kidney disease

2011

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During the past few years, remarkable advances have been made in the understanding and the management of parathyroid diseases in patients with chronic kidney disease (CKD). One of the important insights is the identification of fibroblastic growth factor 23, which has greatly reshaped our understanding of secondary hyperparathyroidism (SHPT). The recent introduction of calcimimetic cinacalcet hydrochloride has led to a major breakthrough in the management of SHPT. Recognition of circulating molecular forms of parathyroid hormone (PTH) is also a major milestone in the accurate assessment of parathyroid function in CKD. Primary hyperparathyroidism should also be considered in patients with CKD, because it can cause various renal manifestations and can also occur as a sporadic disease in these patients. Hypoparathyroidism is occasionally seen in dialysis patients in the setting of diabetes mellitus and malnutrition-inflammation complex syndrome, as well as after parathyroidectomy for advanced SHPT. For patients with adynamic bone disease due to hypoparathyroidism and/or skeletal resistance to PTH, teriparatide, a PTH analog, may have potential for improving bone metabolism and reducing the risk of fracture. In this review, we summarize our current knowledge on diseases of the parathyroid gland in CKD patients, with a particular focus on recent work in the field.

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Section: Treatment Of Shptmentioning

confidence: 99%

Diseases of the parathyroid gland in chronic kidney disease

2011

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“…But one study has demonstrated that PEIT is effective in the treatment of single parathyroid adenomas [20]. Koiwa et al [11] also had similar results, reporting that for patients with only one hyperplastic gland (>0.5 cm 3 ) PEIT had superior efficacy rates.…”

Section: Discussionmentioning

confidence: 93%

“…A number of patients fail to respond to medical therapy and may have to undergo parathyroidectomy (PTX) [4]. Percutaneous ethanol injection therapy (PEIT) was first reported by Solbiati et al [5] as an alternative to PTX in patients with high surgical risk and its effectiveness had already been documented by other authors [6,7,8,9,10,11]. However, a high recurrence rate is a frequent problem because of a patient’s lack of cooperation, ectopic parathyroid mass and, mainly, incomplete treatment.…”

Section: Introductionmentioning

confidence: 99%

Role of the Parathyroid Gland Vascularization Index in Predicting Percutaneous Ethanol Injection Efficacy in Refractory Uremic Hyperparathyroidism

Chen

Lu²,

Lin³

et al. 2010

Nephron Clin Pract

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Aims: To evaluate the role of the quantitative vascularization index (VI) as a measure of the completeness of percutaneous ethanol injection therapy (PEIT). Methods: A total of 37 dialysis patients with secondary hyperparathyroidism refractory to medical therapy received PEIT. We analyzed the role of a quantitative marker of parathyroid adenoma activity, i.e. VI, flow index and vascular flow index as measured by 3-dimensional Doppler ultrasound with a 3-dimensional histogram software, for all patients before treatment and at 1 month and 6 months after PEIT. Results: Serum intact parathyroid hormone (i-PTH) level showed a strong positive correlation with the VI both before (p < 0.001) and after (p < 0.001) PEIT. There was no correlation between i-PTH level and the volume of the gland either before (p = 0.697) or after (p = 0.564) PEIT. One month after PEIT, 20 patients (group 1) reached the target of i-PTH ≤300 pg/ml and 17 patients (group 2) did not. Group 2 patients had significantly greater VI and i-PTH prior to PEIT than group 1 patients (42.23 ± 8.38 vs. 14.95 ± 8.07, p <0.001 and 1,447 ± 243 vs. 859 ± 231, p < 0.001 respectively). Conclusion: A higher VI indicates a higher i-PTH, and the VI may be a reliable predictor of the completeness of PEIT.

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“…According to the Guidelines of the Japanese Society for Parathyroid Intervention, PEIT is recommended in patients with one large parathyroid gland [105]. Koiwa et al analyzed to what extent the number of hyperplastic gland influence the PEIT effect, finding a better rate of success in terms of efficacy and remission period in those patients with one hyperplastic parathyroid gland [106]. Ethanol injection also represents a reasonable option in cases of persistence of SHPT after PTx.…”

Section: Percutaneous Direct Injection Therapymentioning

confidence: 99%

Advances in pharmacotherapy for secondary hyperparathyroidism

Rodríguez

Rodríguez‐Ortiz

2015

Expert Opinion on Pharmacotherapy

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PTH increases from early stages of renal disease. One of the goals in pre-dialysis is the prevention of hyperphosphatemia and the maintenance of Ca levels in the normal range. The management of hyperparathyroidism in dialysis requires control of phosphorus level. In this stage, the decision to use calcimimetics and vitamin D derivatives should be made according to serum levels of Ca and phosphorus.

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Efficacy of percutaneous ethanol injection therapy (PEIT) is related to the number of parathyroid glands in haemodialysis patients with secondary hyperparathyroidism

Abstract: Superior results in efficacy rate, remission period and risk of relapse are obtained when PEIT is restricted to patients with one hyperplastic gland > or =0.5 cm(3).

Cited by 43 publications

References 20 publications

Diseases of the parathyroid gland in chronic kidney disease

Diseases of the parathyroid gland in chronic kidney disease

Role of the Parathyroid Gland Vascularization Index in Predicting Percutaneous Ethanol Injection Efficacy in Refractory Uremic Hyperparathyroidism

Advances in pharmacotherapy for secondary hyperparathyroidism

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