Paratireoidectomia na doença renal crônica: efeitos no ganho de peso e na melhora da qualidade de vida

Abstract

RESUMO Objetivo: avaliar o benefício de paratireoidectomia em pacientes submetidos à hemodiálise, em relação ao estado nutricional e bioquímico, composição corporal e a qualidade de vida. Métodos: estudo longitudinal envolvendo 28 adultos em programa de hemodiálise, com hiperparatireoidismo secundário grave, avaliados antes e um ano após a cirurgia. Critérios de inclusão: níveis de paratormônio dez vezes superior ao valor de referencia e doença renal crônica em programa de hemodiálise. O índice de massa corporal foi utilizado para classificação do estado nutricional. A bioimpedância elétrica para avaliação da composição corporal. A análise bioquímica incluiu dosagem de lipídios e marcadores do metabolismo ósseo. A qualidade de vida foi avaliada pelo questionário SF36 (Short Form Health Survey). Todos os pacientes foram submetidos à paratireoidectomia total com implante em antebraço. Resultados: houve ganho significativo de peso corporal (61,7 vs 66,0 kg; p<0,001), da massa celular corporal (22,0 vs 24,5 kg/m2; p=0,05) e da qualidade de vida (p=0,001) após a cirurgia. Com relação ao metabolismo ósseo, PTH intacto, cálcio, fósforo e fosfatase alcalina, se estabilizaram e houve melhora em parâmetros bioquímicos, tais como albumina e hemoglobina. Conclusão: a paratireoidectomia melhora a sobrevida em pacientes de hemodiálise e está associada a aumento de peso, ganho de massa óssea e melhoria na qualidade de vida.

Impact of Subtotal Parathyroidectomy on Clinical Parameters and Quality of Life in Hemodialysis Patients with Secondary Hyperparathyroidism

“…Three months postoperatively, clinical parameters were re-evaluated in the study population, and significant weight gain was noticed (preoperative BMI: 19.6±2.3 kg/m 2 vs. postoperative BMI: 20.4±2.7 kg/m 2 , P <0.001). In agreement with these results, Valente-Da-Silva et al [5] reported that PTX with forearm implantation performed in ESRD patients on regular HD was associated with weight gain. An increase in weight after PTX could be explained by the fall of serum phosphorus levels, which have a toxic cellular effect that causes the total body mass to decrease [16].…”

“…Peters et al [8] found that significant decreases in serum phosphorus and intact PTH levels occurred after PTX, while there was a non-significant difference in serum calcium levels. On the contrary, in 2017, Valente-Da-Silva et al [5] found significant decreases in PTH and phosphorus levels after total PTX with a forearm implant, in association with significant decreases in calcium levels 1 year after surgery. This documented decrease in serum calcium levels may have been related to reduced calcium intake or a longer effect of surgery [5].…”

“…On the contrary, in 2017, Valente-Da-Silva et al [5] found significant decreases in PTH and phosphorus levels after total PTX with a forearm implant, in association with significant decreases in calcium levels 1 year after surgery. This documented decrease in serum calcium levels may have been related to reduced calcium intake or a longer effect of surgery [5]. It should be noted that the patients included in the current study continued to take calcium tablets and alfacalcidol, guided by calcium level measurements obtained every week.…”

“…Studies have primarily focused on the benefits of PTX by assessing postoperative improvements in laboratory parameters [4]. Recently, Valente-Da-Silva et al [5] observed that improvements in survival in HD patients 1 year after PTX were associated with gains in weight and bone cell mass and improvements in health-related QOL. We hypothesized that the effects of PTX on improving QOL, clinical parameters, and biochemical parameters occur even earlier.…”

Refractory secondary hyperparathyroidism in waiting list for parathyroidectomy: who we should operate first in a quaternary hospital in Brazil regarding survival

“…Similar rates of surgical complication related to early death were predominantly by cardiovascular infectious problems [19–21]. Despite morbidity, there is recent data from Brazilian and Taiwan reporting quality of life improvements in seven out of 8 SF36 criteria one year after PTX, showing the benefits of surgery concerning patient perceptions [22,23].…”