Parathyroidectomy promotes wound healing and prolongs survival in patients with calciphylaxis from secondary hyperparathyroidism

Girotto, John A.; Harmon, John W.; Ratner, Lloyd E.; Nicol, Theresa L.; Wong, Leslie P.; Chen, Herbert

doi:10.1067/msy.2001.117101

Cited by 122 publications

(75 citation statements)

References 23 publications

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“…Moreover, left ventricular function in patients with advanced sHPT and dilated cardiomyopathy was markedly improved by PTx. 40 Other possible mechanisms for post-PTx survival improvement include reduction in fracture risk; 41 improvement in anemia and hypertension, 42 cardiac autonomic nervous system, 43 life-threatening condition of calciphylaxis, 44 immune system, 45 muscle strength, 46 as well as sustained reduction in fibroblast growth factor 23.…”

Section: Discussionmentioning

confidence: 99%

Long–term mortality after parathyroidectomy among chronic kidney disease patients with secondary hyperparathyroidism: a systematic review and meta-analysis

Chen

Wang

et al. 2016

Renal Failure

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Parathyroidectomy (PTx) and medical treatments are both recommended for reducing serum intact parathyroid hormone (iPTH) and curing secondary hyperparathyroidism (sHPT) in patients with chronic kidney disease (CKD), but their therapeutic effects on long-term mortality are not well-known. Thus, we aim to assess such therapeutic effect of PTx. Electronic literatures published on Pubmed, Embase, and Cochrane Central Register of Controlled Trials in any language until 27 November 2015 were systematically searched. All literatures that compared outcomes (survival rate or mortality rate) between PTx-treated and medically-treated CKD patients with sHPT were included. Finally, 13 cohort studies involving 22053 patients were included. Data were extracted from all included literatures in a standard form. The outcomes of all-cause and cardiovascular mortalities were assessed using DerSimonian and Laird's random effects model. We find PTx-treated versus medically-treated patients had a 28% reduction in all-cause mortality and a 37% reduction in cardiovascular mortality. Thus, PTx versus medical treatments might reduce the risks of all-cause and cardiovascular mortalities in CKD patients with sHPT. Further studies with prospective and large-sample clinical trials are needed to find out the real effect of PTx and to assess whether mortality rates differ among patterns of PTx. ARTICLE HISTORY

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Section: Discussionmentioning

confidence: 99%

Long–term mortality after parathyroidectomy among chronic kidney disease patients with secondary hyperparathyroidism: a systematic review and meta-analysis

Chen

Wang

et al. 2016

Renal Failure

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“…Available studies investigating the effect of PTX to treat calciphylaxis were only of retrospective design and reveal considerate bias in this particular condition. While some authors claim a clear survival advantage [68,69], other studies report that PTX did not offer any survival advantage [67]. Although there were no therapeutic clinical trials conducted, PTX was contemplated only in patients with PTH levels >20 pmol/l sustaining a calcium-phosphorus product consistently above 70 refractory to medical treatment (EL 2c) [70].…”

Section: Surgical Treatment Of Patients With Renal Hyperparathyroidismentioning

confidence: 99%

Surgical management of secondary hyperparathyroidism in chronic kidney disease—a consensus report of the European Society of Endocrine Surgeons

Lorenz

Bartsch

Sancho

et al. 2015

Langenbecks Arch Surg

105

130

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Background Despite advances in the medical management of secondary hyperparathyroidism due to chronic renal failure and dialysis (renal hyperparathyroidism), parathyroid surgery remains an important treatment option in the spectrum of the disease. Patients with severe and complicated renal hyperparathyroidism (HPT), refractory or intolerant to medical therapy and patients with specific requirements in prospect of or excluded from renal transplantation may require parathyroidectomy for renal hyperparathyroidism. Methods Present standard and actual controversial issues regarding surgical treatment of patients with hyperparathyroidism due to chronic renal failure were identified, and pertinent literature was searched and reviewed. Whenever applicable, evaluation of the level of evidence concerning diagnosis and management of renal hyperparathyroidism according to standard criteria and recommendation grading were employed. Results were discussed at the 6th Workshop of the European Society of Endocrine Surgeons entitled Hyperparathyroidism due to multiple gland disease: An evidence-based perspective.Results Presently, literature reveals scant data, especially, no prospective randomized studies to provide sufficient levels of evidence to substantiate recommendations for surgery in renal hyperparathyroidism. Appropriate surgical management of renal hyperparathyroidism involves standard bilateral exploration with bilateral cervical thymectomy and a spectrum of four standardized types of parathyroid resection that reveal comparable outcome results with regard to levels of evidence and recommendation. Specific patient requirements may favour one over the other procedure according to individualized demands. Conclusions Surgery for patients with renal hyperparathyroidism in the era of calcimimetics continues to play an important role in selected patients and achieves efficient control of hyperparathyroidism. The overall success rate and longterm control of renal hyperparathyroidism and optimal handling of postoperative metabolic effects also depend on the timely indication, individually suitable type of parathyroid resection and specialized endocrine surgery.

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“…The effectiveness of parathyroidectomy is controversial according to the literature. Some of the studies and case reports support the beneficial effects but others do not (14,21,25,31,32). The significant regression of the calcification in the six months after the operation indicates that hyperparathyroidism could have played a major role in systemic CUA and valvular calcification in this case.…”

Section: Treatment Strategies Of Cuamentioning

confidence: 59%

Endocarditis and Calcific Uremic Arteriolopathy: Is it a Coincidence or an Association? Case Report

Kurultak¹,

Kılıç²,

Sezer³

et al. 2016

Turk Neph Dial Transpl

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The uncommon complications regarding CKD tend to increase in clinical setting because of the chronic kidney disease (CKD) population has been expanding every passing day. Perhaps the most important one of these is calcific uremic arteriolopathy (CUA, calciphylaxis). Calcific uremic arteriolopathy is a clinical syndrome which includes systemic calcification of the small vessels, causes to ischemia, subcutaneous necrosis and it has high mortality and morbidity rates (1,2). There is a large body of data in literature about CUA although very little for its cardiac involvement. Herein we presented a case of calcific endocarditis with CUA and the review of the literature. According to our observation, parathyroidectomy was effective to provide clinical and radiological improvement in the presented case. The clinician should consider adding parathyroidectomy to conventional strategies immediately if the risk of such uncontrolled hyperparathyroidism is present.

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Parathyroidectomy promotes wound healing and prolongs survival in patients with calciphylaxis from secondary hyperparathyroidism

Cited by 122 publications

References 23 publications

Long–term mortality after parathyroidectomy among chronic kidney disease patients with secondary hyperparathyroidism: a systematic review and meta-analysis

Long–term mortality after parathyroidectomy among chronic kidney disease patients with secondary hyperparathyroidism: a systematic review and meta-analysis

Surgical management of secondary hyperparathyroidism in chronic kidney disease—a consensus report of the European Society of Endocrine Surgeons

Endocarditis and Calcific Uremic Arteriolopathy: Is it a Coincidence or an Association? Case Report

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