Secondary hyperparathyroidism (HPT) is frequent in dialysis patients. Parathyroidectomy (PTX) is indicated for patients who failed medical therapy. We reviewed the data from 184 dialysis patients who underwent PTX between January 2015 and January 2023. We aimed to evaluate the short and long term outcomes of PTX in dialysis patients, comparing the conservative 3/4 versus 7/8 techniques in this population.166 dialysis patients with secondary HPT were included. A conservative subtotal PTX (sPTX) 7/8 was performed in 72% of patients and sPTX 3/4 in 28% of them. Severe postoperative hypocalcaemiaocurred in 45 patients (27%). Hypocalcaemia was significantly more frequent in the sPTX 7/8 group (p = 0.012). One case of persistent HPT (0.6%) and 20 cases of recurrence (12%) were diagnosed. Recurrence was more frequent in the sPTX 3/4 group (15%). No deaths were reported during the perioperative period.
References
[1]
Graciolli, F.G., Neves, K.R., Barreto, F., et al. (2017) The Complexity of Chronic Kidney Disease Mineral and Bone Disorder across Stages of Chronic Kidney Disease. Kidney International, 91, 1436-1446. https://doi.org/10.1016/j.kint.2016.12.029
[2]
Veyrat, M., Fessi, H., Haymann, J.-P., Ronco, P., Lacau St Guily, J. and Périé, S. (2019) Conservative Three-Quarter versus Subtotal Seven-Eighths Parathyroidectomy in Secondary Hyperparathyroidism. European Annals of Otorhinolaryngology, Head and Neck Diseases, 136, 63-68. https://doi.org/10.1016/j.anorl.2018.09.003
[3]
Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Update Work Group (2017) KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). KidneyInternationalSupplements, 7, 1-59. https://doi.org/10.1016/j.kisu.2017.04.001
[4]
Zhang, L.X., Zhang, B., Liu, X.Y., Wang, Z.M., Qi, P., Zhang, T.Y., et al. (2022) Advances in the Treatment of Secondary and Tertiary Hyperparathyroidism. Frontiers in Endocrinology, 13, Article 1059828. https://doi.org/10.3389/fendo.2022.1059828
[5]
Fukagawa, M., Yokoyama, K., Koiwa, F., Taniguchi, M., Shoji, T., Kazama, J.J., et al. (2013) Clinical Practice Guideline for the Management of Chronic Kidney Disease-Mineral and Bone Disorder. Therapeutic Apheresis and Dialysis, 17, 247-288. https://doi.org/10.1111/1744-9987.12058
[6]
Guideline Working Group and Japanese Society for Dialysis Therapy (2008) Clinical Practice Guideline for the Management of Secondary Hyperparathyroidism in Chronic Dialysis Patients. Therapeutic Apheresis and Dialysis, 12, 514-525. https://doi.org/10.1111/j.1744-9987.2008.00648.x
[7]
Rudser, K.D., De Boer, I.H., Dooley, A., Young, B. and Kestenbaum, B. (2007) Fracture Risk after Parathyroidectomy among Chronic Hemodialysis Patients. Journal of the American Society of Nephrology, 18, 2401-2407. https://doi.org/10.1681/ASN.2007010022
[8]
Abdelhadi, M. and Nordenström, J. (1998) Bone Mineral Recovery after Parathyroidectomy in Patients with Primary and Renal Hyperparathyroidism. The Journal of Clinical Endocrinology & Metabolism,83, 3845-3851. https://doi.org/10.1210/jcem.83.11.5249
[9]
Komaba, H., Taniguchi, M., Wada, A., Iseki, K., Tsubakihara, Y. and Fukagawa, M. (2015) Parathyroidectomy and Survival among Japanese Hemodialysis Patients with Secondary Hyperparathyroidism. Kidney International, 88, 350-359. https://doi.org/10.1038/ki.2015.72
[10]
Komaba, H., Hamano, T., Fujii, N., Moriwaki, K., Wada, A., Masakane, I., et al. (2022) Parathyroidectomy vs Cinacalcet among Patients Undergoing Hemodialysis. The Journal of Clinical Endocrinology & Metabolism,107, 2016-2025. https://doi.org/10.1210/clinem/dgac142
[11]
Alvarado, L., Sharma, N., Lerma, R., Dwivedi, A., Ahmad, A., Hechanova, A., et al. (2022) Parathyroidectomy versus Cinacalcet for the Treatment of Secondary Hyperparathyroidism in Hemodialysis Patients. World Journal of Surgery, 46, 813-819. https://doi.org/10.1007/s00268-022-06439-7
[12]
Komaba, H., Moriwaki, K., Goto, S., Yamada, S., Taniguchi, M., Kakuta, T., et al. (2012) Cost-Effectiveness of Cinacalcet Hydrochloride for Hemodialysis Patients with Severe Secondary Hyperparathyroidism in Japan. American Journal of Kidney Diseases, 60, 262-271. https://doi.org/10.1053/j.ajkd.2011.12.034
[13]
Narayan, R., Perkins, R.M., Berbano, E.P., Yuan, C.M., Neff, R.T., Sawyers, E.S., et al. (2007) Parathyroidectomy versus Cinacalcet Hydrochloride-Based Medical Therapy in the Management of Hyperparathyroidism in ESRD: A Cost Utility Analysis. American Journal of Kidney Diseases, 49, 801-813. https://doi.org/10.1053/j.ajkd.2007.03.009
[14]
Madorin, C., Owen, R.P., Fraser, W.D., Pellitteri, P.K., Radbill, B., Rinaldo, A., et al. (2012) The Surgical Management of Renal Hyperparathyroidism. European Archives of Oto-Rhino-Laryngology, 269, 1565-1576. https://doi.org/10.1007/s00405-011-1833-2
[15]
Isaksson, E., Ivarsson, K., Akaberi, S., Muth, A., Prütz, K.G., Clyne, N., et al. (2019) Total versus Subtotal Parathyroidectomy for Secondary Hyperparathyroidism. Surgery, 165, 142-150. https://doi.org/10.1016/j.surg.2018.04.076
[16]
Fotheringham, J., Balasubramanian, S.P., Harrison, B. and Wilkie, M. (2011) Post Parathyroidectomy Parathyroid Hormone Levels: The Impact on Patient Survival—A Single-Centre Study in a Stage 5 Chronic Kidney Disease Population. Nephron Clinical Practice,119, c113-c120. https://doi.org/10.1159/000326683
[17]
Bashir, S.O., Aamer, M.A., Omer, H.A. and Morsy, M.D. (2016) Penile Calcific Uremic Arteriolopathy Occurring Postparathyroidectomy in a Hemodialysis Patient. Saudi Journal of Kidney Diseases and Transplantation, 27, 1265-1269. https://doi.org/10.4103/1319-2442.194685
[18]
Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group (2009) KDIGO Clinical Practice Guideline for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney International Supplements,76, S1-S130. https://doi.org/10.1038/ki.2009.188
[19]
Zhu, M., Zhang, Z., Lin, F., Miao, J., Wang, P., Zhang, C., et al. (2018) Therapeutic Experience of Severe and Recurrent Secondary Hyperparathyroidism in a Patient on Hemodialysis for 18 Years: A Case Report. Medicine, 97, e10816. https://doi.org/10.1097/MD.0000000000010816
[20]
Ermer, J.P., Kelz, R.R., Fraker, D.L. and Wachtel, H. (2019) Intraoperative Parathyroid Hormone Monitoring in Parathyroidectomy for Tertiary Hyperparathyroidism. Journal of Surgical Research, 244, 77-83. https://doi.org/10.1016/j.jss.2019.06.020
[21]
Lau, W.L., Obi, Y. and Kalantar-Zadeh, K. (2018) Parathyroidectomy in the Management of Secondary Hyperparathyroidism. Clinical Journal of the American Society of Nephrology,13, 952-961. https://doi.org/10.2215/CJN.10390917
[22]
Albuquerque, R.F.C., Carbonara, C.E.M., Martin, R.C.T., Dos Reis, L.M., Do Nascimento, C.P.J., Arap, S.S., et al. (2018) Parathyroidectomy in Patients with Chronic Kidney Disease: Impacts of Different Techniques on the Biochemical and Clinical Evolution of Secondary Hyperparathyroidism. Surgery, 163, 381-387. https://doi.org/10.1016/j.surg.2017.09.005
[23]
National Kidney Foundation (2003) K/DOQI Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease. American Journal of Kidney Diseases,42, S1-S201.
[24]
Dotzenrath, C., Cupisti, K., Goretzki, P., Mondry, A., Vossough, A., Grabensee, B., et al. (2003) Operative Treatment of Renal Autonomous Hyperparathyroidism: Cause of Persistent or Recurrent Disease in 304 Patients. Langenbeck’s Archives of Surgery, 387, 348-354. https://doi.org/10.1007/s00423-002-0322-x
[25]
Numano, M., Tominaga, Y., Uchida, K., Orihara, A., Tanaka, Y. and Takagi, H. (1998) Surgical Significance of Supernumerary Parathyroid Glands in Renal Hyperparathyroidism. World Journal of Surgery, 22, 1098-1103. https://doi.org/10.1007/s002689900524
[26]
Proye, C., Carneille, B. and Sautier, M. (1990) Hyperparathyroidie chez l’insuffisant renal chronique: Parathyroidectomie subtotale ou parathyroidectomie totale avec autotransplantation? JournaldeChirurgie, 127, 136-140.
[27]
Brunt, L.M. and Wells Junior, S.A. (1983) Surgical Treatment of Secondary Hyperparathyroidism. AnnalesChirurgiaeetGynaecologiae, 72, 139-145.
[28]
Henry, J.F., Denizot, A., Audiffret, J. and France, G. (1990) Results of Reoperations for Persistent or Recurrent Secondary Hyperparathyroidism in Hemodialysis Patients. World Journal of Surgery, 14, 303-306. https://doi.org/10.1007/BF01658510
[29]
Saxe, A. (1983) Parathyroid Transplantation: A Review. Surgery, 95, 507-524.
[30]
Dubost, C.I., Kracht, M., Assens, P., Sarfati, E., Zingraff, J. and Drüeke, T. (1986) Reoperation of Secondary Hyperparathyroidism in Hemodialysis Patients. World Journal of Surgery, 10, 654-659. https://doi.org/10.1007/BF01655548
[31]
Tanaka, Y., Seo, H., Tominaga, Y., Funahashi, H., Matsui, N. and Takagi, H. (1993) Factors Related to the Recurrent Hyperfunction of Autografts after Total Parathyroidectomy in Patients with Severe Secondary Hyperparathyroidism. Surgery Today, 23, 220-227. https://doi.org/10.1007/BF00309231
[32]
Walgenbach, S., Hommel, G. and Junginger, T. (1998) Prospektive Evaluation of Parathyroid Graft Function after Total Parathyroidectomy and Heterotopic Autotransplantation in Renal Hyperparathyroidism by Bilateral Determination of Intact Parathormone in Cubital Venous Blood. World Journal of Surgery, 22, 93-98. https://doi.org/10.1007/s002689900355
[33]
Gu, C., Ye, Z., Wang, Y., Wang, Q., Qi, J., Chen, J., et al. (2020) Therapeutic Efficacy of Two Surgical Methods on the Secondary Hyperparathyroidism. Gland Surgery, 9, 321-328. https://doi.org/10.21037/gs.2020.03.08