Parathyroidectomy for the attainment of NKF-K/DOQI™ and KDIGO recommended values for bone and mineral metabolism in dialysis patients with uncontrollable secondary hyperparathyroidism

Kovačević, Bojan; Ignjatović, Mile; Živaljević, Vladan; Cuk, Vladimir; Šćepanović, Milena; Petrovic, Zaklina; Paunović, Ivan

doi:10.1007/s00423-011-0901-9

Cited by 29 publications

(22 citation statements)

References 24 publications

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“…Comparing our short-term results in light of K/DOQI targets with those of a previous study [10], our study found similar improvements in serum Ca and Ca × P following PTX. Interestingly, our results also showed serum iPTH level improved significantly after PTX.…”

Section: Discussionsupporting

confidence: 73%

“…Although these two guidelines were based on limited evidence and their validities were unclear, their recommendation ranges for serum Ca, P and PTH seem advisable for patients undergoing surgical PTX. However, there are limited data demonstrating the efficacy of PTX to help dialysis patients with refractory secondary HPT to achieve the recommended targets of the NKF-K/DOQI™ [9,10] and KDIGO guidelines. Also, long-term results regarding the Ca, P, PTH balance after PTX in dialysis patients are not available [10].…”

Section: Introductionmentioning

confidence: 99%

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Short- and Long-Term Impact of Subtotal Parathyroidectomy on the Achievement of Bone and Mineral Parameters Recommended by Clinical Practice Guidelines in Dialysis Patients: A 12-Year Single-Center Experience

Tsai¹,

Peng²,

Yang³

et al. 2013

Blood Purif

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Background/Aims: The short- and long-term impact of parathyroidectomy (PTX) on the parameters of mineral bone disease in dialysis patients with severe secondary hyperparathyroidism (HPT) remains unclear. Methods: A retrospective chart review of 401 consecutive dialysis patients who underwent subtotal PTX by one surgeon was performed. We checked serum levels of calcium (Ca), phosphorus (P), and intact parathyroid hormone (iPTH) for 3 consecutive days, and then monthly for Ca, P, and tri-monthly for iPTH postoperatively. Patients with available laboratory data within the 1st to 6th postoperative months were included in the short-term follow-up group and those with at least 6 months available data were in the long-term follow-up one. Results: Patients (short-term group, n = 401, and long-term group, n = 94) had severely uncontrolled serum iPTH levels, Ca, P and Ca × P before PTX. In the short-term group, percentages of cases achieving K/DOQI targets for serum Ca, Ca × P, and iPTH and KDIGO ones for serum Ca, P, and iPTH after PTX, significantly improved compared with those before operation (all p < 0.05). In the long-term group (mean follow-up of 43 ± 29 months), the percentage of achieved targets for serum iPTH in both guidelines and for serum Ca and Ca × P in the K/DOQI recommendation also improved postoperatively (all p < 0.05). Conclusions: Achievements of K/DOQI recommended values for serum Ca, Ca × P, iPTH and KDIGO recommendations for iPTH can be successfully reached by subtotal PTX in medically refractory, secondary HPT in dialysis patients both during short- and long-term follow-ups.

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Section: Discussionsupporting

confidence: 73%

Section: Introductionmentioning

confidence: 99%

Short- and Long-Term Impact of Subtotal Parathyroidectomy on the Achievement of Bone and Mineral Parameters Recommended by Clinical Practice Guidelines in Dialysis Patients: A 12-Year Single-Center Experience

Tsai¹,

Peng²,

Yang³

et al. 2013

Blood Purif

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“…For these patients, parathyroid surgery can be regarded as the preferable therapeutic tool for targeting the recommended ranges for serum calcium, phosphate and PTH levels. Therefore, PTX remains a valuable tool to attain the NKF-K/DOQI recommendations for serum calcium, phosphorus and calcium phosphate product in dialysis patients with renal HPT not responding to medical treatment with effective decrease of these parameters not only from a surgical perspective [27,28].…”

Section: Non-surgical Guidelines and Role Of Parathyroid Surgerymentioning

confidence: 99%

Surgical management of secondary hyperparathyroidism in chronic kidney disease—a consensus report of the European Society of Endocrine Surgeons

Lorenz

Bartsch

Sancho

et al. 2015

Langenbecks Arch Surg

108

130

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Background Despite advances in the medical management of secondary hyperparathyroidism due to chronic renal failure and dialysis (renal hyperparathyroidism), parathyroid surgery remains an important treatment option in the spectrum of the disease. Patients with severe and complicated renal hyperparathyroidism (HPT), refractory or intolerant to medical therapy and patients with specific requirements in prospect of or excluded from renal transplantation may require parathyroidectomy for renal hyperparathyroidism. Methods Present standard and actual controversial issues regarding surgical treatment of patients with hyperparathyroidism due to chronic renal failure were identified, and pertinent literature was searched and reviewed. Whenever applicable, evaluation of the level of evidence concerning diagnosis and management of renal hyperparathyroidism according to standard criteria and recommendation grading were employed. Results were discussed at the 6th Workshop of the European Society of Endocrine Surgeons entitled Hyperparathyroidism due to multiple gland disease: An evidence-based perspective.Results Presently, literature reveals scant data, especially, no prospective randomized studies to provide sufficient levels of evidence to substantiate recommendations for surgery in renal hyperparathyroidism. Appropriate surgical management of renal hyperparathyroidism involves standard bilateral exploration with bilateral cervical thymectomy and a spectrum of four standardized types of parathyroid resection that reveal comparable outcome results with regard to levels of evidence and recommendation. Specific patient requirements may favour one over the other procedure according to individualized demands. Conclusions Surgery for patients with renal hyperparathyroidism in the era of calcimimetics continues to play an important role in selected patients and achieves efficient control of hyperparathyroidism. The overall success rate and longterm control of renal hyperparathyroidism and optimal handling of postoperative metabolic effects also depend on the timely indication, individually suitable type of parathyroid resection and specialized endocrine surgery.

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“…This recommendation may have been based on observational, not-randomized clinical trial evidence describing potentially beneficial effects on short-term laboratory parameters and/or on longer-term clinical outcomes including fracture and death (5,6). Some (7)(8)(9)(10)(11)(12) but not all (5) reports suggest that short-term adverse outcomes related to parathyroidectomy produce only modest adverse consequences. However, many of these reports are based on single-center experiences, and may represent highly selected and high-performing surgical units (7)(8)(9)(10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

“…Some (7)(8)(9)(10)(11)(12) but not all (5) reports suggest that short-term adverse outcomes related to parathyroidectomy produce only modest adverse consequences. However, many of these reports are based on single-center experiences, and may represent highly selected and high-performing surgical units (7)(8)(9)(10)(11)(12). In addition, the comparability of nonparathyroidectomized control groups in these studies is unknown.…”

Section: Introductionmentioning

confidence: 99%

Clinical Outcomes after Parathyroidectomy in a Nationwide Cohort of Patients on Hemodialysis

Ishani

Liu

Wetmore

et al. 2015

Clinical Journal of the American Society of Nephrology

127

122

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Background and objectives Patients receiving dialysis undergo parathyroidectomy to improve laboratory parameters in resistant hyperparathyroidism with the assumption that clinical outcomes will also improve. However, no randomized clinical trial data demonstrate the benefits of parathyroidectomy. This study aimed to evaluate clinical outcomes up to 1 year after parathyroidectomy in a nationwide sample of patients receiving hemodialysis.Design, setting, participants, & measurements Using data from the US Renal Data System, this study identified prevalent hemodialysis patients aged $18 years with Medicare as primary payers who underwent parathyroidectomy from 2007 to 2009. Baseline characteristics and comorbid conditions were assessed in the year preceding parathyroidectomy; clinical events were identified in the year preceding and the year after parathyroidectomy. After parathyroidectomy, patients were censored at death, loss of Medicare coverage, kidney transplant, change in dialysis modality, or 365 days. This study estimated cause-specific event rates for both periods and rate ratios comparing event rates in the postparathyroidectomy versus preparathyroidectomy periods.Results Of 4435 patients who underwent parathyroidectomy, 2.0% died during the parathyroidectomy hospitalization and the 30 days after discharge. During the 30 days after discharge, 23.8% of patients were rehospitalized; 29.3% of these patients required intensive care. In the year after parathyroidectomy, hospitalizations were higher by 39%, hospital days by 58%, intensive care unit admissions by 69%, and emergency room/ observation visits requiring hypocalcemia treatment by 20-fold compared with the preceding year. Causespecific hospitalizations were higher for acute myocardial infarction (rate ratio, 1.98; 95% confidence interval, 1.60 to 2.46) and dysrhythmia (rate ratio 1.4; 95% confidence interval1.16 to 1.78); fracture rates did not differ (rate ratio 0.82; 95% confidence interval 0.6 to 1.1).Conclusions Parathyroidectomy is associated with significant morbidity in the 30 days after hospital discharge and in the year after the procedure. Awareness of clinical events will assist in developing evidence-based risk/benefit determinations for the indication for parathyroidectomy.

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Parathyroidectomy for the attainment of NKF-K/DOQI™ and KDIGO recommended values for bone and mineral metabolism in dialysis patients with uncontrollable secondary hyperparathyroidism

Cited by 29 publications

References 24 publications

Short- and Long-Term Impact of Subtotal Parathyroidectomy on the Achievement of Bone and Mineral Parameters Recommended by Clinical Practice Guidelines in Dialysis Patients: A 12-Year Single-Center Experience

Short- and Long-Term Impact of Subtotal Parathyroidectomy on the Achievement of Bone and Mineral Parameters Recommended by Clinical Practice Guidelines in Dialysis Patients: A 12-Year Single-Center Experience

Surgical management of secondary hyperparathyroidism in chronic kidney disease—a consensus report of the European Society of Endocrine Surgeons

Clinical Outcomes after Parathyroidectomy in a Nationwide Cohort of Patients on Hemodialysis

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