Total parathyroidectomy improves survival of hemodialysis patients with secondary hyperparathyroidism

Iwamoto, Noriyuki; Sato, Nodoka; Nishida, Masaya; Hashimoto, Tsuyoshi; Kobayashi, Hiroyuki; Yamasaki, Satoru; Ono, Toshihiko; Nishimura, Masato; Tokoro, Toshiko; Sakoda, Chikako; Murakawa, Mayuko; Okino, Koji; Okamoto, Y; Imai, Ryo; Adachi, Naoto; Ninomiya, Kanji; Mabuchi, Hisao; Koyama, Masaki; Nakanouchi, Tsuneyuki; Iseki, Kunitoshi

doi:10.5301/jn.5000056

Cited by 45 publications

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“…Most studies adjusted a wide range of potential confounders to investigate the association between PTx and all-cause mortality, including age, sex, body mass index (BMI), diabetes, duration of dialysis, and dialysis modality. Twelve studies presented data with all-cause mortality [19][20][21][22][23][24][25][26][27][28][29]31 and six studies with cardiovascular mortality. 19,20,23,26,28,30 Table 1 lists the key characteristics of the 13 studies.…”

Section: Selection and Characteristics Of Studiesmentioning

confidence: 99%

“…Of them, 37 studies were retrieved for detailed evaluation, and finally 24 studies were excluded due to absence of information on the outcomes of interest (19 articles) or provision of data only in abstract form (5 articles). Finally, 13 studies [19][20][21][22][23][24][25][26][27][28][29][30][31] fulfilled the eligibility criteria ( Figure 1), with 10052 PTx-treated patients and 12001 medically-treated patients (totally 22053 patients). The 13 studies were all cohort studies with sample sizes from 20 to 4558 patients, and reported prevalence rates of diabetes from 0% to 44.3%.…”

Section: Selection and Characteristics Of Studiesmentioning

confidence: 99%

“…We examined the 11 trials [19][20][21][22][23][24][25][26]28,29,31 that investigated the effect of PTx versus medical treatment on mortality against follow-up duration (<36 vs. 36 months). In the six trials with follow-up duration <36 months, the mortality rates are significantly different between PTxtreated and medically-treated patients (Figure 4).…”

Section: Effect Of Ptx Versus Medical Treatments On Mortality Againstmentioning

confidence: 99%

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Long–term mortality after parathyroidectomy among chronic kidney disease patients with secondary hyperparathyroidism: a systematic review and meta-analysis

Chen

Wang

et al. 2016

Renal Failure

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Parathyroidectomy (PTx) and medical treatments are both recommended for reducing serum intact parathyroid hormone (iPTH) and curing secondary hyperparathyroidism (sHPT) in patients with chronic kidney disease (CKD), but their therapeutic effects on long-term mortality are not well-known. Thus, we aim to assess such therapeutic effect of PTx. Electronic literatures published on Pubmed, Embase, and Cochrane Central Register of Controlled Trials in any language until 27 November 2015 were systematically searched. All literatures that compared outcomes (survival rate or mortality rate) between PTx-treated and medically-treated CKD patients with sHPT were included. Finally, 13 cohort studies involving 22053 patients were included. Data were extracted from all included literatures in a standard form. The outcomes of all-cause and cardiovascular mortalities were assessed using DerSimonian and Laird's random effects model. We find PTx-treated versus medically-treated patients had a 28% reduction in all-cause mortality and a 37% reduction in cardiovascular mortality. Thus, PTx versus medical treatments might reduce the risks of all-cause and cardiovascular mortalities in CKD patients with sHPT. Further studies with prospective and large-sample clinical trials are needed to find out the real effect of PTx and to assess whether mortality rates differ among patterns of PTx. ARTICLE HISTORY

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Section: Selection and Characteristics Of Studiesmentioning

confidence: 99%

Section: Selection and Characteristics Of Studiesmentioning

confidence: 99%

Section: Effect Of Ptx Versus Medical Treatments On Mortality Againstmentioning

confidence: 99%

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Long–term mortality after parathyroidectomy among chronic kidney disease patients with secondary hyperparathyroidism: a systematic review and meta-analysis

Chen

Wang

et al. 2016

Renal Failure

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“…KBY'de paratiroidektomi operasyonu %10-30 hastaya uygulanıyor (27)(28)(29). Türk Nefroloji Derneği 2012 registry değerlerinde SHPT de ilaç kullanım oranlarına baktığımızda SHPT tanılı hastaların %46,36'sının tedavi aldığını tespit ettik.…”

Section: Bulgularunclassified

Cost Analysis between Operated Patients with Secondary Hyperparathyroidism and Patients Receiving Medical Treatment

Gürkan¹,

Sipahi²,

Tamer³

2015

Turk Neph Dial Transpl

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ÖzAmAç: Sekonder hiperparatiroidi (SHPT) kronik böbrek yetmezlikli (KBY) hastalarda yaygın bir bozukluktur. Medikal tedaviye dirençli hastalarda cerrahi tedavi uygulanmaktadır. Çalışmanın amacı, SHPT'li hastalar arasından hastanemizde paratiroidektomi operasyonu geçirmiş hastalar ile opere olmamış, medikal tedavi alan hastalar arasındaki yıllık ilaç tedavi maliyetlerini karşılaştırmaktır. Gereç ve YÖnTemler:Paratiroidektomi operasyonu geçiren SHPT'li 9 hasta retrospektif olarak değerlendirildi. Çalışmaya 9 erişkin hasta alındı. Demografik özellikleri benzer olan, medikal tedavi alan SPHT'li 9 hasta kontrol grubu olarak belirlendi. İki grubun ilaç maliyetleri Sosyal Güvenlik Kurumu (SGK) ilaç satış fiyatları üzerinden belirlenerek karşılaştırma yapıldı.BulGulAr: Paratiroidektomi operasyonu olan 9 hastanın operasyon öncesi PTH bazal değeri ortalaması 1919±594 pg/ml tespit edildi. İlaç tedavisi alan 9 hastanın PTH değeri ortalaması ise 1426±317 pg/ml idi. Operasyon sonrası yapılan takip sırasında hastalarımızdan iki tanesinde nüks gelişti. Yıllık ilaç maliyeti opere olan hastalarda ortalama 785±998 Türk Lirası (TL), opere olmayan hastalarda 3948±953 TL olarak tespit edildi. İki grup arasında maliyet açısından anlamlı farklılık bulundu (p<0,05).SOnuç: KBY'ne bağlı gelişen SHPT'li paratiroidektomi operasyonu olmuş hastalarda, operasyon sonrası yıllık ilaç maliyeti anlamlı oranda azalmaktadır. SPHT'li hastalarda tıbbi tedaviye yeterli cevap alınamadığında cerrahi tedaviye ilaç maliyetleri de göz önüne alınarak daha erken başvurulabilinir.AnAhTAr SÖzcükler: Kronik böbrek yetmezliği, Sekonder hiperparatiroidi, İlaç tedavisi, Paratiroidektomi, Tedavi maliyeti ABSTrAcT OBJecTIVe: Secondary hyperparathyroidism (SHPT) is a common disorder in patients with chronic renal failure (CRF). Surgical treatment is performed for patients resistant to medical treatment. The purpose of this study was to compare the costs of annual medication treatment between patients who had parathyroidectomy operation and unoperated patients. mATerIAl and meThODS: 9 patients with SHPT who had parathyroidectomy operations were evaluated retrospectively. 9 patients with SHPT with similar demographic characteristics who were receiving medical treatment were determined as the control group. Medication costs of two groups were specified and compared according to the sale prices of medications of Social Security Institution (SSI). reSulTS:The average PTH basal values of 9 patients who had parathyroidectomy operations were 1919±594 pg/ml before operation. Relapse developed in two patients. In the third year, the average PTH value of 9 patients receiving SHPT medication treatment was 1426±317 pg/ml. The annual medication cost was averagely 785±998 TRY for operated patients and 3948±953 TRY for unoperated patients. There was a significant difference between two groups in terms of cost (p<0.05).cOncluSIOn: Annual medication costs showed a significant decrease after operation. When sufficient response cannot be received to the treatment in patients with SHPT, s...

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“…Evidence of potential survival benefit after parathyroidectomy came from retrospective studies (77,126,127) but one retrospective study suggested that patients with persistently very low PTH levels post-parathyroidectomy had a higher 5-year mortality (128). Furthermore, there is concern relating to bone turnover as parathyroidectomy is likely to turn high turnover bone disease to adynamic bone disease (129) which is also associated with worse vascular calcification (130).…”

Section: Surgicalmentioning

confidence: 99%

Pharmacological Management of Secondary Hyperparathyroidism in Patients with Chronic Kidney Disease

Salam

Khwaja

Wilkie

2016

Drugs

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or Article Brief (if supplied by editors): As a 'Therapy in Practice' article, we would like this to provide a succinct, up-to-date clinically orientated guide to the optimum management of secondary hyperparathyroidism in patients with chronic kidney disease. The review should include an appropriate background to the development of SHPT. It should focus primarily on pharmacological treatments but as appropriate, non-pharmacological approaches (dietary, surgical) may be discussed to fully place pharmacological therapy in context. Submission date: 31 st March 2016Word count: 4156 Compliance with Ethical StandardsFunding and conflict of interest statement from each author: Takeaway messages from the article SHPT is associated with adverse outcomes in CKD and dialysis patients  Optimum PTH level is unclear in pre-dialysis CKD and the recommended range is wide for dialysis patients.  Management of SHPT is largely pharmacological focussing on lowering PTH  PTH lowering treatment has not shown improved cardiovascular risk, fractures and mortality. AbstractSecondary hyperparathyroidism (SHPT) is a common complication of CKD and is part of the chronic kidney disease-mineral bone disorder (CKD-MBD). SHPT is associated with increased risk of fracture and mortality, thus SHPT control is recommended as kidney function declines. Effective SHPT management becomes more difficult once skeletal and cardiovascular adverse effects associated with severe SHPT have become established. However, interventional studies to lower parathyroid hormone (PTH) have so far shown inconsistent results in improving patient-centred outcomes such as mortality, cardiovascular events and fracture. Pharmacological treatment effect on PTH level is also inconsistent between predialysis CKD and dialysis patients which adds to the complexity of SHPT management. This review aims to give an overview on the pathophysiology, pharmacological and non-pharmacological treatment for SHPT in CKD including some of the limitations of current therapeutic options.

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Total parathyroidectomy improves survival of hemodialysis patients with secondary hyperparathyroidism

Abstract: Total parathyroidectomy was associated with better survival, probably due to decreased cardiovascular mortality.

Cited by 45 publications

References 0 publications

Long–term mortality after parathyroidectomy among chronic kidney disease patients with secondary hyperparathyroidism: a systematic review and meta-analysis

Long–term mortality after parathyroidectomy among chronic kidney disease patients with secondary hyperparathyroidism: a systematic review and meta-analysis

Cost Analysis between Operated Patients with Secondary Hyperparathyroidism and Patients Receiving Medical Treatment

Pharmacological Management of Secondary Hyperparathyroidism in Patients with Chronic Kidney Disease

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