Parathyroidectomy in dialysis patients

Francisco, Ángel; Fresnedo, Gema Fernández; Rodrigo, Emilio; Piñera, Celestino; Amado, J. A.; Arias, Manuel

doi:10.1046/j.1523-1755.61.s80.27.x

Cited by 44 publications

(37 citation statements)

References 30 publications

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“…The standard operation performed for secondary HPTH is bilateral neck dissection, which allows us to perform either a subtotal parathyroidectomy or total parathyroidectomy with or without autotransplantation [6][7][8]. Many experienced surgeons tend to perform total parathyroidectomies with transcervical thymectomies and immediately implant the parathyroid tissue in the forearm.…”

Section: Discussionmentioning

confidence: 99%

Radioguided parathyroidectomy in forearm graft for recurrent hyperparathyroidism

Ardito

Revelli²,

Giustozzi³

et al. 2012

BJR

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ABSTRACT. We report a peculiar case of recurrent hyperparathyroidism caused by hyperplasia of a forearm graft implanted following a total parathyroidectomy in a 38-year-old patient with chronic renal failure. The forearm graft hyperplasia was detected using 99 Tc m -sestamibi scanning, which identified hyperplastic transplanted parathyroid tissue in the forearm of the patient. During the initial surgery, the surgeon failed to mark the parathyroid tissue with sutures or clips to facilitate locating it. Therefore, we referred the patient for radioguided surgery. This surgical procedure allowed us to locate and completely remove the hyperfunctioning transplanted parathyroid tissue.

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Section: Discussionmentioning

confidence: 99%

Radioguided parathyroidectomy in forearm graft for recurrent hyperparathyroidism

Ardito

Revelli²,

Giustozzi³

et al. 2012

BJR

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“…An analysis of four randomized controlled trials shows that use of cinacalcet is associated with decreased need for PTX [24]. Currently 1-2% of patients with 2HPT will undergo surgery each year, with *10% eventually undergoing PTX [30,31].…”

Section: Surgical Indicationsmentioning

confidence: 99%

The surgical management of renal hyperparathyroidism

Madorin

Owen

Fraser

et al. 2011

Eur Arch Otorhinolaryngol

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Secondary and tertiary hyperparathyroidism (HPT) develop in patients with renal failure due to a variety of mechanisms including increased phosphorus and fibroblast growth factor 23 (FGF23), and decreased calcium and 1,25-dihydroxy vitamin D levels. Patients present with various bone disorders, cardiovascular disease, and typical laboratory abnormalities. Medical treatment consists of controlling hyperphosphatemia, vitamin D/analog and calcium administration, and calcimimetic agents. Improved medical therapies have led to a decrease in the use of parathyroidectomy (PTX). The surgical indications include parathyroid hormone (PTH) levels >800 pg/ml associated with hypercalcemia and/or hyperphosphatemia despite medical therapy. Other indications include calciphylaxis, fractures, bone pain or pruritis. Transplant recipients often show decreased PTH, calcium and phosphorus levels, but some will have persistent HPT. Evidence suggests that PTX may cause deterioration in renal graft function in the short-term calling into the question the indications for PTX in these patients. Pre-operative imaging is only occasionally helpful except in re-operative PTX. Operative approaches include subtotal PTX, total PTX with or without autotransplantation, and possible thymectomy. Each approach has its proponents, advantages and disadvantages which are discussed. Intraoperative PTH monitoring has a high positive predictive value of cure but a poor negative predictive value and therefore is of limited utility. Hypocalcemia is the most common complication requiring aggressive calcium administration. Benefits of surgery may include improved survival, bone mineral density and alleviation of symptoms.

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“…The majority of end-stage renal disease (ESRD) patients demonstrates secondary hyperparathyroidism (sHPT), which enhances with prolongation of renal replacement therapy (RRT) duration [1] and requires parathyroidectomy (PTx) in the most severe cases [2]. Mineral bone disorders, including sHPT, are closely associated with cardiovascular complications and contribute to morbidity and mortality in hemodialysis (HD) subjects [3].…”

Section: Introductionmentioning

confidence: 99%

The Calcium-Sensing Receptor Gene Polymorphism rs1801725 and Calcium-Related Phenotypes in Hemodialysis Patients

Grzegorzewska

Bednarski

Świderska

et al. 2018

Kidney Blood Press Res

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Background/Aims: The calcium-sensing receptor gene (CASR) rs1801725 variant is responsible for a non-conservative amino-acid change (A986S) in the calcium-sensing receptor cytoplasmic tail. We hypothesized that rs1801725 polymorphism might be helpful in understanding Ca-related abnormalities in HD patients. Methods: In 1215 subjects (245 on cinacalcet), we determined the associations of rs1801725 with secondary hyperparathyroidism (sHPT)-related laboratory parameters, PTH-decreasing effect of cinacalcet hydrochloride, coronary artery disease (CAD), myocardial infarction (MI), nephrolithiasis-related ESRD, and mortality. CASR rs7652589(AT) haplotypes and rs1801725 epistatic interactions with vitamin D signaling pathway genes were examined for associations with selected phenotypes. Results: The rs1801725 variant allele showed an increasing independent effect on plasma PTH (P_corrected = 0.009). CASR rs7652589_rs1801725 AT haplotype was associated with 1.7-fold higher frequency of PTH levels over 437 pg/mL than the reference haplotype GG (P = 0.001). CASR rs7652589_rs1801725 AG haplotype was 1.5-fold more frequent in nephrolithiasis-related ESRD than the GG haplotype (P = 0.004). There were no significant associations between rs1801725, CAD, MI, and response to cinacalcet. Variant homozygosity of rs1801725 correlated independently with higher infection-related mortality compared with heterozygosity (HR 7.95, 95%CI 2.15 – 29.37, P = 0.003) and major homozygosity (HR 5.89, 95%CI 1.69 – 20.55, P = 0.040). CASR rs1801725 did not show epistatic interactions with vitamin D signaling pathway genes concerning tested associations. Conclusion: The variant allele of CASR rs1801725 solely and together with the variant allele of rs7652589 increases risk of more advanced sHPT. Homozygosity of the rs1801725 variant allele contributes to infection-related mortality in HD patients.

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Parathyroidectomy in dialysis patients

Cited by 44 publications

References 30 publications

Radioguided parathyroidectomy in forearm graft for recurrent hyperparathyroidism

Radioguided parathyroidectomy in forearm graft for recurrent hyperparathyroidism

The surgical management of renal hyperparathyroidism

The Calcium-Sensing Receptor Gene Polymorphism rs1801725 and Calcium-Related Phenotypes in Hemodialysis Patients

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