Impact of Parathyroidectomy on Serum FGF23 and Soluble Klotho in Hemodialysis Patients With Severe Secondary Hyperparathyroidism

Abstract

Our results suggest that the parathyroid gland is not the major site of soluble Klotho production in patients with end-stage renal disease, and the production of Klotho by other organ(s) is affected by alterations in mineral metabolism or medications taken after PTx.

Effect of Cinacalcet and Vitamin D Analogs on Fibroblast Growth Factor-23 during the Treatment of Secondary Hyperparathyroidism

“…Both animal and human studies have shown that PTH administration increases FGF-23 (6-10), supporting the hypothesis that PTH is an important regulator of FGF-23. Reductions in PTH after parathyroidectomy have been associated with reductions in FGF-23 in animals with experimental renal failure and patients with ESRD (7,23,24). Therefore, it is plausible that reducing PTH concentrations with medical intervention in patients with SHPT might directly result in reductions in FGF-23 concentrations.…”

Parathyroidectomy or Calcimimetic to Treat Hypercalcemia after Kidney Transplantation?

“…The study by Purnell et al 3 in this issue of the Journal of the American Society of Nephrology suggests that the gap between blacks and whites in kidney allograft survival-an outcome measure-is narrowing significantly. This, arguably, is one of the most important measures of health disparity in ESRD management and runs counter to one of the longest standing observations differentiating black versus white transplant recipients.…”

“…1 The treatment of severe hyperparathyroidism in patients with ESRD by either parathyroidectomy or cinacalcet generally leads to a marked decrease in serum calcium, phosphate, parathyroid hormone (PTH), and as shown more recently, serum fibroblast growth factor-23. 2,3 When such patients receive a kidney graft, generally polyclonal parathyroid hyperplasia will slowly regress because of the recovery of renal function and correction of metabolic and endocrine disturbances. This is not so with tumoral growth, where the response of parathyroid secretion and proliferation to physiologic regulatory mechanisms is reduced or lost.…”

“…This, arguably, is one of the most important measures of health disparity in ESRD management and runs counter to one of the longest standing observations differentiating black versus white transplant recipients. Using a large United States national data registrythe Scientific Registry of Transplant Recipients-Purnell et al 3 examined KT outcomes over the past two decades. The analysis was stratified by race and broken down into an early cohort-follow-up from 1990 to 1992-and three contemporary time periods as comparisons beginning in 2007.…”

The Effects of Different Exercise Modalities on s-Klotho after Surgery: A Call for Action

“…Takahashi et al [21] while aiming to "determine the impact of parathyroidectomy [PTx] on serum FGF23 and soluble Klotho levels in patients with severe secondary hyperparathyroidism" suggested that "the parathyroid gland is not the major site of soluble Klotho production in patients with end-stage renal disease, and the production of Klotho by other organ(s) is affected by alterations in mineral metabolism or medications taken after PTx".…”