Parathyroidectomy decreases serum intact parathyroid hormone and calcium levels and prolongs overall survival in elderly hemodialysis patients with severe secondary hyperparathyroidism

Wan, Jinnan; Li, Wenhuan; Zhong, Yuan

doi:10.1002/jcla.22696

Cited by 15 publications

(9 citation statements)

References 13 publications

(30 reference statements)

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“…However, the control of PTX on the rate of reaching the target range of laboratory indicators in patients with secondary hyperparathyroidism still needs to be further explored. Similar to a previous study [25], we found that the levels of iPTH, serum calcium, and phosphorus decreased significantly after PTX. In a recent large prospective, multicenter epidemiological observational study in France [26], 9010 incident patients were included.…”

Section: Discussionsupporting

confidence: 91%

Evaluation of laboratory parameters and symptoms after parathyroidectomy in dialysis patients with secondary hyperparathyroidism

et al. 2019

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Objectives: The aim of the study was to evaluate the laboratory parameters and symptoms after parathyroidectomy (PTX) in dialysis patients with secondary hyperparathyroidism (SHPT), and to briefly analyze the different therapeutic effects of the three surgical methods. Methods: A total of 182 dialysis patients who underwent PTX between February 2012 and January 2018 at the Second Affiliated Hospital of Soochow University were included in this study and followed for 12 months. Laboratory parameters such as calcium (Ca), phosphorus (P), alkaline phosphatase (ALP), and intact parathyroid hormone (iPTH) were measured before and after operation. According to the follow-up time and type of operation, we calculated the percentage of laboratory indicators reaching the recommended range of the KDIGO guidelines after surgery. We also analyzed the improvement of bone pain and pruritus, as well as surgical complications. Results: After the operation, the levels of iPTH, Ca, and P decreased significantly at each time point. ALP increased at the first postoperative week and gradually decreased to normal range after 3 months. Symptoms, such as bone pain and pruritus, were significantly relieved. According to the follow-up time and three surgical methods (subtotal parathyroidectomy, total parathyroidectomy, total parathyroidectomy plus autologous transplantation), we found that the ratio of each laboratory parameter reaching the recommended range of KDIGO guidelines was significantly different. Conclusion: PTX is a safe and effective therapy for treating SHPT that is refractory to medical therapies and accompanied by related signs and symptoms in dialysis patients. All three operative techniques were effective in controlling SHPT.

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Section: Discussionsupporting

confidence: 91%

Evaluation of laboratory parameters and symptoms after parathyroidectomy in dialysis patients with secondary hyperparathyroidism

et al. 2019

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“…The advantage of this operation is that the function of the transplanted glands can be monitored by measuring the iPTH levels of the bilateral forearms 23 . Our study showed that PTX was effective in the treatment of SHPT, which was consistent with the results of previous studies 4,24,25 . Patients who cannot tolerate surgery can be treated with ultrasound-guided thermal ablation.…”

Section: Discussionsupporting

confidence: 93%

Recommend-Response and Complications Comparing Radiofrequency Ablation Versus Parathyroidectomy for Secondary Hyperparathyroidism in Dialysis Patients

Ren

Zheng

et al. 2021

Preprint

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Introduction : To compare the efficacy and safety of ultrasound(US)-guided radiofrequency ablation (RFA) and parathyroidectomy (PTX) in the treatment of secondary hyperparathyroidism (SHPT). Methods In this retrospective study, we divided patients into PTX (n=53) and RFA (n=47) groups. The primary outcomes were the proportion of patients achieved the target range of iPTH concentrations(124-558pg/mL) and the long-term prognosis. The secondary outcomes were the differences in the changes of iPTH, calcium, and phosphorus over time and the incidence of adverse events. Results There was rarely difference in baseline characteristics between the two groups. Primary outcomes: The iPTH concentrations of 25.8% of patients in the PTX group and 51.3% of the RFA group were within the recommended range at the endpoint (P=0.031). Survival analysis revealed that the difference in all-cause mortality and cumulative response rate between the two groups was not statistically significant (P=0.902, P=0.141, respectively). Secondary outcomes: The iPTH concentrations in PTX group and RFA group dropped sharply after treatment and were 82.30±163.21pg/mL and 279.96±306.57pg/mL (P<0.001). There was no difference in the trend of iPTH, calcium, and phosphorus levels between the two groups over time(P>0.05). In addition, the incidence of infection and the hospital stay in the RFA group were significantly less. And preoperative bone-specific alkaline phosphatase concentration was a risk factor for postoperative hypocalcemia. Conclusion US-guided RFA was minimally invasive and no less than PTX in terms of cumulative response rate and complications in the treatment of severe SHPT in maintenance dialysis patients and may be used as an alternative technique to PTX, which need further studies to confirm.

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“…27,28 These findings were similar to the previous results. The decrease of PTH after nonabdominal surgery in this study was probably attributed to the high proportion of parathyroidectomy, which was the side-effect of parathyroidectomy, 29 but not to APD. In addition, APD treatment has a side effect, that is, the patient's albumin decreased significantly, considered may be related to the surgical stress consumption and APD itself lead to protein loss.…”

Section: Discussionmentioning

confidence: 50%

<p>Efficacy of APD in perioperative period of non-abdominal operation for peritoneal dialysis patients</p>

Zhang¹,

Feng²,

Lü³

et al. 2019

IJGM

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Whether automated peritoneal dialysis (APD) is a feasible strategy in perioperative period of uremic patients undergoing nonabdominal surgery remains unclear. This study was conducted to research the perioperative management and the best choice of dialysis modalities for peritoneal dialysis patients. Materials and methods: A retrospective analysis was made on the clinical data of 58 ESRD patients who had received peritoneal dialysis for more than three months were treated with APD during perioperative period from July 2015 to March 2018 in the Second Affiliated Hospital of Soochow University. The differences of clinical parameters, such as urine volume, ultrafiltration volume, hemoglobin, renal function and electrolytes were collected and analyzed before and after APD. Results: The vital signs of 58 patients were stable after APD treatment, and there were no significant differences in 24-hour urine volume, hemoglobin and electrolytes (calcium, phosphorus, potassium, sodium) before and after surgery (P>0.05). Compared with those before treatment, the amount of ultrafiltration increased significantly (P<0.05), creatinine, urea nitrogen and parathyroid hormone decreased significantly (P<0.05), while albumin decreased (P<0.05). Conclusion: Application of APD for peritoneal dialysis patients undergoing nonabdominal surgery during the perioperative period is safe and effective.

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Parathyroidectomy decreases serum intact parathyroid hormone and calcium levels and prolongs overall survival in elderly hemodialysis patients with severe secondary hyperparathyroidism

Cited by 15 publications

References 13 publications

Evaluation of laboratory parameters and symptoms after parathyroidectomy in dialysis patients with secondary hyperparathyroidism

Evaluation of laboratory parameters and symptoms after parathyroidectomy in dialysis patients with secondary hyperparathyroidism

Recommend-Response and Complications Comparing Radiofrequency Ablation Versus Parathyroidectomy for Secondary Hyperparathyroidism in Dialysis Patients

<p>Efficacy of APD in perioperative period of non-abdominal operation for peritoneal dialysis patients</p>

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