Full normalization of severe hypertension after parathryoidectomy – a case report and systematic review

Sofronie, Andreea; Kooij, Isabelle; Bursot, Claude; Santagati, Giulia; Coindre, Jean‐Philippe; Piccoli, Giorgina Barbara

doi:10.1186/s12882-018-0900-y

Cited by 7 publications

(6 citation statements)

References 28 publications

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“…Incidentally, the present study also found a reduction in systolic, diastolic and pulse pressure after parathyroidectomy. Other small observational studies have reported similar findings (35). The postulated mechanisms included correction of hypercalcemia, attenuation of vascular calcification and vascular stiffness and a direct effect of PTH on the vascular wall (36).…”

Section: Discussionmentioning

confidence: 52%

Improvement of nutritional status after parathyroidectomy in patients receiving maintenance hemodialysis

et al. 2023

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Aims/IntroductionParathyroidectomy is associated with improved survival in patients with end-stage kidney disease. Protein-energy wasting (PEW) is common in patients with kidney failure and predicts poor outcomes. Recent clinical trials have linked hyperparathyroidism to PEW. The present retrospective cohort study examined whether parathyroidectomy was associated with improvement in nutritional status in maintenance hemodialysis patients.Materials and methodsOne hundred twenty-nine maintenance hemodialysis patients who had successful parathyroidectomy during 2012–2018 were identified (PTX group) and matched 1:1 to 479 patients with parathyroid hormone (PTH) levels ≤1,000 pg./mL (non-PTX control group) and 187 patients with PTH levels >1,000 pg./mL (pre-PTX control group) by propensity score. The matchings yielded 120 matched pairs from PTX and non-PTX groups (cohort 1) and 76 matched pairs from PTX and pre-PTX groups (cohort 2). Baseline and follow-up nutritional parameters associated with PEW were compared over the 12-month study period.ResultsIn cohort 1, substantially lower serum albumin and serum creatinine/body surface area (Cr/BSA) and higher proportions of patients with serum albumin ≤38 g/L (low albumin) and serum Cr/BSA ≤380 μmol/L/m2 (low Cr/BSA) were observed in the PTX group. These parameters improved significantly after parathyroidectomy. Total lymphocyte count (TLC) was comparable at baseline but the percentage of patients with TLC <800 cells/mm3 (low TLC) decreased substantially after parathyroidectomy. At follow-up, serum albumin, serum Cr/BSA and proportions of patients with low albumin and Cr/BSA became comparable with the non-PTX control group. The percentage of patients with low TLC became lower in the PTX group. Mixed-models analysis confirmed significant differences in the changes in serum albumin, serum Cr/BSA, and proportions of patients with low albumin and TLC between the two groups. In cohort 2, nutritional parameters were comparable at baseline. At follow-up, serum Cr/BSA was higher and proportions of patients with body mass index ≤18.5 kg/m2, low TLC and low Cr/BSA were lower in the PTX group. Weight gain was more frequent and of greater magnitude in the PTX group in both cohorts. A substantial reduction in blood pressure was also observed in the PTX group.ConclusionSevere hyperparathyroidism was associated with nutritional impairment which improved considerably after parathyroidectomy.

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Section: Discussionmentioning

confidence: 52%

Improvement of nutritional status after parathyroidectomy in patients receiving maintenance hemodialysis

et al. 2023

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“…Numerous other reports have been published since, and recently a metanalysis of eight studies including 94 hemodialysis patients [28][29][30][31][32][33][34] on this focus was published by Giorgina Piccoli's group. Although based on a limited number of patients, the metanalysis study results evidenced a reduction of both systolic and diastolic BP in response to PTX [17]. The significance of this beneficial effect was more evident on systolic blood pressure leading to a confirmation of the hypothesis that BP changes after hyperparathyroidism correction are linked to vascular stiffness reduction.…”

Section: The Pathogenetic Cross-link Between Hypertension and Hyperpamentioning

confidence: 79%

“…A possible association between SHPTH and hypertension in hemodialysis patients has been widely reported in the literature and several pathogenetic mechanisms have also been disclosed [16][17][18][19][20]. A hypertension correction has been described following the decrease of iPTH plasma levels in hemodialysis patients undergone to parathyroidectomy [16,17,28] and oral calcimimetics administration [36].…”

Section: Discussionmentioning

confidence: 99%

“…However, other hypertensive mechanisms have also been described. A possible pathophysiological cross-link between hypertension and hyperparathyroidism has been widely reported with evidence of BP normalization after parathyroidectomy [16,17]. Thus, hyperparathyroidism-related hypertensive mechanisms in hemodialysis patients have been investigated with interesting results.…”

Section: Introductionmentioning

confidence: 99%

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Secondary Hyperparathyroidism and Hypertension: An Intriguing Couple

Simeoni

Perna

Fuiano

2020

JCM

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Secondary hyperparathyroidism (SHPTH) is a major complication in patients on maintenance hemodialysis burdened with high cardiovascular risk. Hypertension is also a high prevalence complication contributing to an increase in the mortality rate in hemodialysis patients. A possible association between SHPTH and hypertension has been widely reported in the literature and several pathogenetic mechanisms have been described. There is evidence that the decrease of plasma iPTH levels are correlated with hypertension correction in hemodialysis patients undergoing parathyroidectomy and oral calcimimetics administration. We have observed a similar behaviour also in a patient on chronic hemodialysis treated with Etelcalcetide. Even if this is an isolated observation, it could stimulate future investigation, possibly in dedicated clinical trials.

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“…While it is impossible to reduce the effect of the entangled derangements of such a complex system to one element only, the correction of hyperparathyroidism is still an unmet challenge, in which many questions have remained unanswered. Parathyroid hormone (PTH) is a uremic toxin, high levels of which are associated not only with the classic hallmarks of bone disease, and are characterized by an increase in calcium, phosphate and FGF-23, all of them associated with an increased mortality, but also with anemia, hypertension, neuromyopathy, dysfunction of the peripheral and central nervous systems, and various metabolic effects, including dyslipidemia and impaired insulin secretion [10][11][12][13][14][15][16][17][18][19][20][21][22].…”

Section: Introductionmentioning

confidence: 99%

New Intravenous Calcimimetic Agents: New Options, New Problems. An Example on How Clinical, Economical and Ethical Considerations Affect Choice of Treatment

Piccoli

Trabace

Chatrenet

et al. 2020

IJERPH

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Background. Dialysis treatment is improving, but several long-term problems remain unsolved, including metabolic bone disease linked to chronic kidney disease (CKD-MBD). The availability of new, efficacious but expensive drugs (intravenous calcimimetic agents) poses ethical problems, especially in the setting of budget limitations. Methods. Reasons of choice, side effects, biochemical trends were discussed in a cohort of 15 patients (13% of the dialysis population) who stared treatment with intravenous calcimimetics in a single center. All patients had previously been treated with oral calcimimetic agents; dialysis efficacy was at target in 14/15; hemodiafiltration was employed in 10/15. Median Charlson Comorbidity Index was 8. The indications were discussed according to the principlist ethics (beneficience, non maleficience, justice and autonomy). Biochemical results were analyzed to support the clinical-ethical choices. Results. In the context of a strict clinical and biochemical surveillance, the lack of side effects ensured “non-maleficence”; efficacy was at least similar to oral calcimimetic agents, but tolerance was better. Autonomy was respected through a shared decision-making model; all patients appreciated the reduction of the drug burden, and most acknowledged better control of their biochemical data. The ethical conflict resides in the balance between the clinical “beneficience, non-maleficience” advantage and “justice” (economic impact of treatment, potentially in attrition with other resources, since the drug is expensive and included in the dialysis bundle). The dilemma is more relevant when a patient’s life expectancy is short (economic impact without clear clinical advantages), or when non-compliance is an issue (unclear advantage if the whole treatment is not correctly taken). Conclusions. In a context of person-centered medicine, autonomy, beneficence and non-maleficence should weight more than economic justice. While ethical discussions are not aimed at finding “the right answer” but asking “the right questions”, this example can raise awareness of the importance of including an ethical analysis in the choice of “economically relevant” drugs.

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Full normalization of severe hypertension after parathryoidectomy – a case report and systematic review

Cited by 7 publications

References 28 publications

Improvement of nutritional status after parathyroidectomy in patients receiving maintenance hemodialysis

Improvement of nutritional status after parathyroidectomy in patients receiving maintenance hemodialysis

Secondary Hyperparathyroidism and Hypertension: An Intriguing Couple

New Intravenous Calcimimetic Agents: New Options, New Problems. An Example on How Clinical, Economical and Ethical Considerations Affect Choice of Treatment

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