Near total parathyroidectomy for the treatment of renal hyperparathyroidism

Puccini, Marco; Ceccarelli, Cristina; Meniconi, Ophelia; Zullo, Claudia; Prosperi, Valerio; Miccoli, Mario; Urbani, Lucio; Buccianti, P

doi:10.21037/gs.2017.09.12

Cited by 9 publications

(12 citation statements)

References 17 publications

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“…There is the potential for late graft failure, possibly due to scar maturation causing local ischemia 272,297. Conversely, the grafts can become hyperplastic with time and can infiltrate into surrounding structures and blood vessels 272,307. In addition, THPT can develop at the site of an autograft after kidney transplantation due to the persistence of nodular tissue in the autograft 308.…”

Section: Planning Of Surgerymentioning

confidence: 99%

“…264,265,270 There is no consensus on the size of the remnant left behind; various studies have described remnants weighing 30 to 50 mg, 40 to 50 mg or 40 to 80 mg, or measuring 1/3 to 1/2 the gland, half the size of a normal gland, 2 to 3 times the size of a normal gland, or a 3 × 3 × 3 mm remnant. 264,265,[267][268][269]271,272 Once the remnant is marked and examined for viability, the remaining glands can be excised. 166 Upon closing, some surgeons mark the level of the remnant with a non-absorbable suture in the strap muscles.…”

Section: Subtotal Ptxmentioning

confidence: 99%

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The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Secondary and Tertiary Renal Hyperparathyroidism

Dream

Kuo

et al. 2022

Annals of Surgery

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Objective: To develop evidence-based recommendations for safe, effective, and appropriate treatment of secondary (SHPT) and tertiary (THPT) renal hyperparathyroidism. Background: Hyperparathyroidism is common among patients with chronic kidney disease, end-stage kidney disease, and kidney transplant. The surgical management of SHPT and THPT is nuanced and requires a multidisciplinary approach. There are currently no clinical practice guidelines that address the surgical treatment of SHPT and THPT. Methods: Medical literature was reviewed from January 1, 1985 to present January 1, 2021 by a panel of 10 experts in SHPT and THPT. Recommendations using the best available evidence was constructed. The American College of Physicians grading system was used to determine levels of evidence. Recommendations were discussed to consensus. The American Association of Endocrine Surgeons membership reviewed and commented on preliminary drafts of the content. Results: These clinical guidelines present the epidemiology and pathophysiology of SHPT and THPT and provide recommendations for work-up and management of SHPT and THPT for all involved clinicians. It outlines the preoperative, intraoperative, and postoperative management of SHPT and THPT, as well as related definitions, operative techniques, morbidity, and outcomes. Specific topics include Pathogenesis and Epidemiology, Initial Evaluation, Imaging, Preoperative and Perioperative Care, Surgical Planning and Parathyroidectomy, Adjuncts and Approaches, Outcomes, and Reoperation. Conclusions: Evidence-based guidelines were created to assist clinicians in the optimal management of secondary and tertiary renal hyperparathyroidism.

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Section: Planning Of Surgerymentioning

confidence: 99%

Section: Subtotal Ptxmentioning

confidence: 99%

The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Secondary and Tertiary Renal Hyperparathyroidism

Dream

Kuo

et al. 2022

Annals of Surgery

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“… 17 showed that patients who had the most prominent reduction in serum calcium were those with the highest baseline concentrations of PTH and alkaline phosphatase. Higher baseline PTH concentrations also have been associated with a higher risk of sustained hypocalcemia and higher needs for calcium supplementation after parathyroidectomy 15, 16, 18, 19, 20. Collectively, these data suggest that patients with more severe sHPT should be monitored most closely for calcimimetic-induced hypocalcemia.…”

Section: Resultsmentioning

confidence: 90%

Etelcalcetide Is Effective at All Levels of Severity of Secondary Hyperparathyroidism in Hemodialysis Patients

Cunningham

Block

Chertow

et al. 2019

Kidney International Reports

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Introduction Calcimimetics improve parameters of secondary hyperparathyroidism (sHPT) but are mostly initiated when patients have severe disease, potentially limiting effectiveness. We evaluated the effects of etelcalcetide on lowering intact parathyroid hormone, calcium, and phosphate at different disease severity levels. Methods This analysis examined data from 2 parallel, phase 3, randomized, placebo-controlled, 26-week trials conducted in 1023 adult (≥18 years old) patients with sHPT on maintenance hemodialysis. Etelcalcetide effects by baseline intact parathyroid hormone stratum (<600, 600–1000, and >1000 ng/l) on mean percentage change in intact parathyroid hormone; changes in calcium and phosphate; and achieving serum intact parathyroid hormone ≤300 ng/l, phosphate <1.78 mmol/l, and both combined, were assessed. Results Etelcalcetide reduced serum intact parathyroid hormone by a similar percentage across baseline strata. A similar proportion achieved >30% intact parathyroid hormone reduction across strata for the etelcalcetide arms. Parathyroid hormone increased modestly in each placebo-group stratum, most prominently in the lowest stratum. Serum calcium and phosphate concentrations decreased across strata in etelcalcetide-treated patients, with the most pronounced reductions in patients with highest baseline parathyroid hormone. However, the proportion of patients achieving parathyroid hormone, phosphate, and both targets was highest in the lowest baseline parathyroid hormone stratum, where etelcalcetide dose requirements were lowest. Etelcalcetide dose requirement was lowest among patients in the lowest intact parathyroid hormone stratum. Conclusion Etelcalcetide effectively lowered serum intact parathyroid hormone, calcium, and phosphate, irrespective of the severity of secondary hyperparathyroidism. The ability to achieve target goals was greatest, and dose requirement smallest, when etelcalcetide was initiated among patients with the lowest level of disease severity.

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“…Higher baseline PTH concentrations also have been associated with a higher risk of sustained hypocalcemia and higher needs for calcium supplementation after parathyroidectomy. 15,16,[18][19][20] Collectively, these data suggest that patients with more severe sHPT should be monitored most closely for calcimimetic-induced hypocalcemia.…”

Section: Discussionmentioning

confidence: 90%

Faculty Opinions recommendation of Etelcalcetide is effective at all levels of severity of secondary hyperparathyroidism in hemodialysis patients.

Rodríguez

2020

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature

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Introduction: Calcimimetics improve parameters of secondary hyperparathyroidism (sHPT) but are mostly initiated when patients have severe disease, potentially limiting effectiveness. We evaluated the effects of etelcalcetide on lowering intact parathyroid hormone, calcium, and phosphate at different disease severity levels.Methods: This analysis examined data from 2 parallel, phase 3, randomized, placebo-controlled, 26-week trials conducted in 1023 adult ($18 years old) patients with sHPT on maintenance hemodialysis. Etelcalcetide effects by baseline intact parathyroid hormone stratum (<600, 600-1000, and >1000 ng/l) on mean percentage change in intact parathyroid hormone; changes in calcium and phosphate; and achieving serum intact parathyroid hormone #300 ng/l, phosphate <1.78 mmol/l, and both combined, were assessed.Results: Etelcalcetide reduced serum intact parathyroid hormone by a similar percentage across baseline strata. A similar proportion achieved >30% intact parathyroid hormone reduction across strata for the etelcalcetide arms. Parathyroid hormone increased modestly in each placebo-group stratum, most prominently in the lowest stratum. Serum calcium and phosphate concentrations decreased across strata in etelcalcetide-treated patients, with the most pronounced reductions in patients with highest baseline parathyroid hormone. However, the proportion of patients achieving parathyroid hormone, phosphate, and both targets was highest in the lowest baseline parathyroid hormone stratum, where etelcalcetide dose requirements were lowest. Etelcalcetide dose requirement was lowest among patients in the lowest intact parathyroid hormone stratum. Conclusion:Etelcalcetide effectively lowered serum intact parathyroid hormone, calcium, and phosphate, irrespective of the severity of secondary hyperparathyroidism. The ability to achieve target goals was greatest, and dose requirement smallest, when etelcalcetide was initiated among patients with the lowest level of disease severity.

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Near total parathyroidectomy for the treatment of renal hyperparathyroidism

Cited by 9 publications

References 17 publications

The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Secondary and Tertiary Renal Hyperparathyroidism

The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Secondary and Tertiary Renal Hyperparathyroidism

Etelcalcetide Is Effective at All Levels of Severity of Secondary Hyperparathyroidism in Hemodialysis Patients

Faculty Opinions recommendation of Etelcalcetide is effective at all levels of severity of secondary hyperparathyroidism in hemodialysis patients.

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