New clinical guidelines for selective direct injection therapy of the parathyroid glands in chronic dialysis patients

Abstract

In 2000, the Japanese Society for Parathyroid Intervention issued the ‘Guidelines for percutaneous ethanol injection therapy of the parathyroid glands in chronic dialysis patients’. Since then, the concept of ‘selective PEIT’ has been well accepted and the number of patients treated by this method in Japan has increased. Recently, it has been reported that the effect of PEIT differs depending on the degree of nodular hyperplasia. Several new drugs have become available since 2000, and active vitamin D and its analogue have also been used for direct injection into the parathyroids. We present the new ‘Guidelines for selective direct injection therapy of the parathyroid glands in chronic dialysis patients’, a revised version of the 2000 Guidelines. We believe that these new guidelines are useful for selecting direct injection therapy in patients with advanced secondary hyperparathyroidism.

Clinical Practice Guideline for the Management of Chronic Kidney Disease‐Mineral and Bone Disorder

“…Following PEIT, it is important to manage remaining hyperplastic glands with medical therapy, including intravenous VDRA. The indications and techniques for PEIT should follow the guideline by the Japanese Society for Parathyroid Intervention . It must be noted that PEIT often causes adhesion to surrounding tissue, which makes it difficult to identify the recurrent laryngeal nerve and increases the risk of nerve damage during subsequent PTx .…”

Efficacy and safety of ultrasound‐guided radiofrequency ablation of hyperplastic parathyroid gland for secondary hyperparathyroidism associated with chronic kidney disease

“…In addition, parathyroid hormone (PTH) is an essential physiological hormone, and it is difficult to precisely remove the adequate amount of hyperplastic parathyroid gland tissue without completely compromising the iPTH levels . Some investigators attempted alternative methods for the management of secondary HPT, such as ethanol injection and local treatment with calcitriol, but these methods were only tried in patients with refractory secondary HPT who could not tolerate surgery or in patients with recurrent secondary HPT after parathyroidectomy, and the efficacy of these approaches remains unconfirmed.…”

Prevalence and current approaches to the treatment of secondary hyperparathyroidism and its complications in chronic kidney disease: a literature review

“…Распространенность и современные подходы к лечению вторичного гиперпаратиреоза и его осложнений апоптозу клеток околощитовидных желез и являются более безопасными по отношению к окружающим тканям. Впервые данный метод был использован в Японии, где изучалась его безопасность и эффективность [58].…”