The effect of chronic kidney disease on intraoperative parathyroid hormone: A linear mixed model analysis

Abstract

Background: Reduced creatinine clearance is an indication for surgery in asymptomatic primary hyperparathyroidism, and a significant proportion of patients undergoing parathyroidectomy have chronic kidney disease. The purpose of this study was to evaluate the kinetics of intraoperative parathyroid hormone decline during parathyroidectomy in patients who have chronic kidney disease compared with those with who have normal renal function. Methods: This is a single-center, retrospective study of patients with primary hyperparathyroidism undergoing parathyroidectomy (n ¼ 646). Patients were grouped based on estimated glomerular filtration rate greater than (normal renal function) or less than (chronic kidney disease) 60 mL/min/ 1.73m 2 . All patients had intraoperative parathyroid hormone monitoring and 6-month postoperative serum studies to confirm surgical cure. Intraoperative parathyroid hormone kinetic curves were analyzed using a linear mixed model. Results: Despite similar pre-excision values, patients with chronic kidney disease had significantly higher intraoperative parathyroid hormone values at 5 minutes (76 vs 58 pg/mL, P ¼ .02) and 10 minutes (54 vs 37 pg/mL, P ¼ .004) postexcision. No significant difference was observed in whether patients met Miami criterion by 5 minutes (chronic kidney disease 71%, normal renal function 78%, P ¼ .255) or by 10 minutes (chronic kidney disease 95%, normal renal function 96%, P ¼ .751) postexcision. Using a linear mixed model, glomerular filtration rate did not have a significant effect on the change in intraoperative parathyroid hormone over time. Conclusion:Patients with chronic kidney disease had significantly higher postexcision intraoperative parathyroid hormone levels. However, renal function did not affect the change in intraoperative parathyroid hormone over time, nor did renal function ultimately affect the likelihood of meeting the Miami criterion. Intraoperative parathyroid hormone monitoring remains useful in this population, although additional time points may be needed to observe normalization of values.

The value of intraoperative parathyroid hormone monitoring in patients with primary hyperparathyroidism and varying baseline parathyroid hormone levels

“…Studies have shown that kidney function, measured by preoperative creatinine, may have an influence on intraoperative PTH decline because of cross-reactions with PTH metabolites 46 , 47 ; however, several studies have shown that patients with chronic kidney disease that undergo parathyroidectomy demonstrate IOPTH degradation kinetics similar to patients with normal kidney function, thus, the same IOPTH decline should be utilized in patients with normal kidney function and chronic kidney disease 48 , 49 . In this study, no correlation was found between preoperative creatinine and intraoperative PTH decline within the various groups, which is similar to the literature 50 . These results also strengthen the recommendation that the same IOPTH decline should be used in patients with normal and chronic kidney function.…”

Development and validation of a dynamic deep learning algorithm using electrocardiogram to predict dyskalaemias in patients with multiple visits

“…Linear mixed models are typically used to analyse the same effect across all data and the specific effect within individuals in medical research. 19 We developed LMM to predict the ground truth of K + and used the prediction from the corresponding DLM as a predictor variable for both fixed and random effects. In this study, we used each patient with multiple ECG tests as the independent hierarchical level.…”

Hormonal imbalance in patients with chronic renal failure in the pre-dialysis and dialysis periods (part1)

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