Parathyroidectomy Versus Cinacalcet for the Treatment of Secondary Hyperparathyroidism in Hemodialysis Patients

Alvarado, Luis; Sharma, Natasha; Lerma, Roxann; Dwivedi, Alok; Ahmad, Adeel; Hechanova, Lisa Aimee; Payan-Schober, Fernanda; Nwosu, Azikiwe; Alkhalili, Eyas

doi:10.1007/s00268-022-06439-7

Cited by 11 publications

(7 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Even with the recently increased use of calcimimetics, surgery still plays an important role in the treatment of SHPT. While calcimimetic has been reported to have clinical benefits in terms of normalization of electrolytes and lowering parathyroid hormone (PTH) (3,4), its longterm survival benefit cannot be demonstrated by current evidence (5,6). In addition, most medical treatments will be ineffective after a period of application, and approximately 15% of the patients on dialysis will need parathyroidectomy after 5-10 years due to refractoriness to medical treatment or intolerance to side effects related to calcimimetics (1,5,7).…”

Section: Introductionmentioning

confidence: 99%

Risk factors of recurrent secondary hyperparathyroidism after adequate primary surgical treatment

et al. 2023

View full text Add to dashboard Cite

BackgroundSecondary hyperparathyroidism (SHPT) is a common condition in patients with end-stage renal disease (ESRD) who are on dialysis. Parathyroidectomy is a treatment for patients when medical therapy has failed. Recurrence may occur and is indicated for further surgery in the era of improved quality of care for ESRD patients.MethodsWe identified, 1060 patients undergoing parathyroidectomy from January, 2011 to June, 2020. After excluding patients without regular check-up at our institute, primary hyperparathyroidism, or malignancy, 504 patients were enrolled. Sixty-two patients (12.3%, 62/504) were then excluded due to persistent SHPT even after the first parathyroidectomy. We aimed to identify risk factors for recurrent SHPT after the first surgery.ResultsDuring the study period, 20% of patients who underwent parathyroidectomy at our institute (in, 2019) was due to recurrence after a previous parathyroidectomy. There were 442 patients eligible for analysis of recurrence after excluding patients with the persistent disease (n = 62). While 44 patients (9.95%) had recurrence, 398 patients did not. Significant risk factors for recurrent SHPT within 5 years after the first parathyroidectomy, including dialysis start time to first operation time < 3 years (p = 0.046), postoperative PTH >106.5 pg/mL (p < 0.001), and postoperative phosphorus> 5.9 mg/dL (p = 0.016), were identified by multivariate analysis.ConclusionsThe starting time of dialysis to first operation time < 3 years in the patients with dialysis, postoperative PTH> 106.5 pg/mL, and postoperative phosphorus> 5.9 mg/dL tended to have a higher risk for recurrent SHPT within 5 years after primary treatment.

show abstract

Section: Introductionmentioning

confidence: 99%

Risk factors of recurrent secondary hyperparathyroidism after adequate primary surgical treatment

et al. 2023

View full text Add to dashboard Cite

show abstract

“…Nevertheless, patients with SHPT refractory to medical treatment exist ( 25 ). For these patients, PTx is the best treatment and should be indicated without delay to improve their QOL and reduce mortality ( 2 , 150 , 151 ). However, as the number of PTx for SHPT has decreased, consequently endocrine surgeons who have sufficient experience in performing PTx for SHPT are also decreasing.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, in a prospective cohort study from Japan, PTxtreated patients were compared with matched cinacalcet-treated patients, and PTx reduced the risk of mortality, most prominently in patients with intact PTH levels ≥500 pg/mL and those with serum calcium levels ≥10 mg/dL (2). A recent study of the United States Renal Data System and Japanese Society for Dialysis Therapy Renal Data Registry also showed superior 5-year and 6-year survival in the PTx-treated group compared with the cinacalcet-treated group (2,150). Additionally, from the viewpoint of QOL, the superiority of PTx compared with cinacalcet was demonstrated in a systematic review, where the physical component score and mental component score in the 36-item Medical Outcomes Study Short-Form Health Survey were significantly more improved in the PTx-treated patients than in the cinacalcet-treated patients (151).…”

Section: Calcimimetics Treatment Versus Ptxmentioning

confidence: 99%

Treatment for secondary hyperparathyroidism focusing on parathyroidectomy

et al. 2023

View full text Add to dashboard Cite

Secondary hyperparathyroidism (SHPT) is a major problem for patients with chronic kidney disease and can cause many complications, including osteodystrophy, fractures, and cardiovascular diseases. Treatment for SHPT has changed radically with the advent of calcimimetics; however, parathyroidectomy (PTx) remains one of the most important treatments. For successful PTx, removing all parathyroid glands (PTGs) without complications is essential to prevent persistent or recurrent SHPT. Preoperative imaging studies for the localization of PTGs, such as ultrasonography, computed tomography, and 99mTc-Sestamibi scintigraphy, and intraoperative evaluation methods to confirm the removal of all PTGs, including, intraoperative intact parathyroid hormone monitoring and frozen section diagnosis, are useful. Functional and anatomical preservation of the recurrent laryngeal nerves can be confirmed via intraoperative nerve monitoring. Total or subtotal PTx with or without transcervical thymectomy and autotransplantation can also be performed. Appropriate operative methods for PTx should be selected according to the patients’ need for kidney transplantation. In the case of persistent or recurrent SHPT after the initial PTx, localization of the causative PTGs with autotransplantation is challenging as causative PTGs can exist in the neck, mediastinum, or autotransplanted areas. Additionally, the efficacy and cost-effectiveness of calcimimetics and PTx are increasingly being discussed. In this review, medical and surgical treatments for SHPT are described.

show abstract

“… 28 , 29 However, others stated that PTX offered no significant protection against cardiac complications in patients undergoing dialysis. 30 , 31 On the other hand, the EVOLVE trial found that cinacalcet decreased the frequency of cardiovascular complications in older patients with SHPT undergoing dialysis. Yet, this effect was not evident in younger patients.…”

Section: Discussionmentioning

confidence: 99%

Management of pre-renal transplant secondary hyperparathyroidism: parathyroidectomy versus cinacalcet

Elhadedy¹,

El-Kannishy²,

Refaie³

et al. 2023

DIC

View full text Add to dashboard Cite

Background Secondary hyperparathyroidism is a common consequence of end-stage renal disease. Despite the efficacy of kidney transplantation in treating renal failure, many transplant recipients still suffer from persistent or tertiary hyperparathyroidism. Furthermore, the impact of secondary hyperparathyroidism therapy choices on other renal transplant outcomes is poorly understood. Methods We retrieved the clinical data of 334 patients who received a kidney allograft between January 2007 and December 2014 at the Sheffield Teaching Hospitals, NHS Foundation Trust, United Kingdom. We identified three groups: parathyroidectomy group (34 patients), including patients who had parathyroidectomy before transplantation; cinacalcet group (31 patients), including patients who received cinacalcet before transplantation; and control group (269 patients), including patients who receive a transplant in the same period but did not have any evidence of hyperparathyroidism. We reviewed the demographic data, biochemical parameters and graft survival of all groups. Results Patients who underwent parathyroidectomy before transplantation had significantly better post-transplant calcium and parathyroid hormone levels than patients in the cinacalcet group ( p =0.003). In addition, a significantly lower number of patients had tertiary hyperparathyroidism in the parathyroidectomy group than in the cinacalcet group at 1 year of follow-up ( p =0.001). However, short-term and long-term graft survival was comparable in all groups. Conclusions Renal allograft survival was comparable in all groups. However, tertiary hyperparathyroidism was less likely to occur in patients who underwent parathyroidectomy than in those who were administered cinacalcet.

show abstract

Parathyroidectomy Versus Cinacalcet for the Treatment of Secondary Hyperparathyroidism in Hemodialysis Patients

Cited by 11 publications

References 26 publications

Risk factors of recurrent secondary hyperparathyroidism after adequate primary surgical treatment

Risk factors of recurrent secondary hyperparathyroidism after adequate primary surgical treatment

Treatment for secondary hyperparathyroidism focusing on parathyroidectomy

Management of pre-renal transplant secondary hyperparathyroidism: parathyroidectomy versus cinacalcet

Contact Info

Product

Resources

About