Multicenter study on parathyroidectomy (PTX) in Italy: preliminary results

Abstract

PTX prevalence in Italy is stable compared to previous observations, is higher in hemodialysis than in peritoneal dialysis and results in a suboptimal biochemical control.

New scenarios in secondary hyperparathyroidism: etelcalcetide. Position paper of working group on CKD-MBD of the Italian Society of Nephrology

“…In the 2012-2014 timeframe of the survey, in particular, more than 25% of patients treated in the US presented with poorly controlled SHPT (defined as PTH level > 500 pg/ml) [5]. In line with these observations, hyperparathyroidism was reported in a recently published study in as much as 29% of patients receiving chronic hemodialysis in Italy [7]. In addition to such an assessment of the grade of appropriateness in the management of SHPT both in Italy and internationally, DOPPS data show that, in dialysis patients, there's an increase in the risk of cardiovascular mortality and all-cause mortality associated with serum calcium levels > 10 mg/dl, phosphate levels > 7 mg/dl, and PTH levels > 600 pg/ml [8], so as to highlight how much an appropriate control of SHPT and CKD-MBD is still an unmet clinical need.…”

“…Current strategies for the medical treatment of SHPT are grounded in the following criteria: lower the intake of phosphate by careful avoiding food and beverages with "masked" phosphorus content (many preserved foods and alcohol-free beverages) [9,10]; privilege the intake of proteins of vegetal origin which, due to higher content in fiber, cause lower intake of phosphorus so as to reduce animal proteins while avoiding malnutrition; use phosphate binders [10,11]; use vitamin D analogs [7,12,13]; ensuring dialysis appropriateness in dialysis patients, with particular regard to duration; use of calcimimetics ( Table 2). The latter are chemical agents which activate calcium sensing receptor (CaSR) and suppress PTH secretion from the parathyroid glands [1][2][3].…”

Parathyroidectomy and survival in a cohort of Italian dialysis patients: results of a multicenter, observational, prospective study

“…In this paper, we report the prospective, observational part of a multicenter cohort study on PTX that involved 149 Italian dialysis Units, whose protocol was approved by the Ethics Committee of the Policlinico Umberto I in Rome (prot. N° 888/09), and whose baseline data have already been published [ 12 ]. Briefly, in this study, inclusion criteria were age older than 18 years, renal failure requiring dialysis treatment (hemodialysis or peritoneal dialysis) and ability to sign the consent form.…”

“…Indeed, a lower risk of mortality is reported when all three standard biochemical indicators of metabolic control (namely Ca, P and PTH) reach the target levels recommended by K-DOQI at least once [ 9 ]. However, targeting all three biomarkers is not easily accomplished after PTX [ 10 – 12 ]. In fact, in the long term after surgery, hypoparathyroidism is frequent and both low and high levels of PTH are associated with increased cardiovascular morbidity and mortality, in a typically U-shaped modality [ 13 ].…”