Prospective study on dialysis patients after total parathyroidectomy without autoimplant

Chan, Hilda Wai-Han; Chu, Kwok-Hong; Fung, Samuel; Tang, Hon-Lok; Lee, William; Cheuk, Au; Yim, Ka-Fai; Tong, Matthew K.L.; Lee, Kam-Cheong

doi:10.1111/j.1440-1797.2009.01257.x

Cited by 11 publications

(8 citation statements)

References 30 publications

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“…We observed a non-significant elevation of AP from 131 ± 19 to 147 ± 22 U/L in the perioperative period. In contrast to our findings, Chan et al [28] observed a perioperative decrease in AP among 13 patients who underwent total PTX without autotransplantation.…”

Section: Discussioncontrasting

confidence: 54%

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Influence of Parathyroidectomy on Bone Metabolism and Bone Pain in Patients with Secondary Hyperparathyroidism

et al. 2018

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Background: After parathyroidectomy (PTX), hungry bone syndrome leads to hypocalcemia due to bone remineralization. The aim of this pilot study was to analyze changes in markers of bone metabolism in patients with secondary hyperparathyroidism (sHPT) after PTX and to correlate these markers with bone pain measured with a validated questionnaire. Materials and Methods: All patients who underwent PTX for sHPT between March 2010 and February 2012 at out institution were included in this prospective observational pilot study. At the day before surgery and on the 3rd day thereafter, levels of parathyroid hormone (PTH), calcium, osteocalcin, alkaline phosphatase (AP), bone-specific AP (BAP), tartrate-resistant acid phosphatase 5b (TRAP5b), osteoprotegerin (OPG), sclerostin, fibroblast growth factor 23, and Klotho were measured. Additionally, all patients were requested to answer the Brief Pain Inventory preoperatively and on the 5th postoperative day. Results: A total of 35 patients with a mean age of 49.8 years were analyzed. A significant difference between the pre- and postoperative values could be detected in PTH, calcium, BAP, TRAP5b, and sclerostin. The highest correlation of laboratory markers with bone pain was found for preoperative PTH (r = 0.3), postoperative OPG (r = 0.4), postoperative BAP (r = –0.4), and postoperative Klotho (r = –0.4). Conclusions: The present study revealed significant perioperative changes in PTH, BAP, sclerostin, and TRAP5b after PTX. These markers may serve as laboratory markers to monitor bone metabolism in patients with sHPT. PTH, OPG, and sclerostin were the parameters with the closest correlation to bone pain. However, larger prospective trials with a longer follow-up are required to confirm these results.

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Section: Discussioncontrasting

confidence: 54%

“…Bone pain is one of the main symptoms of renal osteopathy in patients with sHPT [28, 57]. In a retrospective study by Low et al [57], a perioperative reduction of bone pain, decreasing from 65 to 3.5%, was observed.…”

Section: Discussionmentioning

confidence: 99%

Influence of Parathyroidectomy on Bone Metabolism and Bone Pain in Patients with Secondary Hyperparathyroidism

et al. 2018

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“…The extent of operative exploration for supernumerary glands may become less controversial with widespread utilization of the intraoperative PTH assay as an adjunct in guiding the completeness of resection. The utilization of intraoperative PTH monitoring may become a useful adjunct for assuring that the patient has undergone an adequate parathyroidectomy in sHPT [22-26]. Patients whose PTH level dropped under 400 ng/L by the removal of parathyroid gland, sHPT could be controlled by medical treatment after the operation.…”

Section: Discussionmentioning

confidence: 99%

Total parathyroidectomy with trace amounts of parathyroid tissue autotransplantation as the treatment of choice for secondary hyperparathyroidism: a single-center experience

Zhuang

Zheng

et al. 2014

BMC Surg

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BackgroundThe aim of the study was to evaluate total parathyroidectomy with trace amounts of parathyroid tissue (30 mg) as a surgical option in secondary hyperparathyroidism (sHPT) treatment.MethodsFrom January 2008 to March 2012, 47 patients underwent parathyroidectomy. Comparisons of demographic data, symptoms, and preoperative or postoperative biochemistry were made between total parathyroidectomy with trace amounts of parathyroid tissue autotransplantation group and total parathyroidectomy group.ResultsOut of 47 cases, 45 had successful operation. 187 parathyroid glands identified at the initial operation were reported in 47 patients. 43 patients had been diagnosed with parathyroid hyperplasia, and 4 patients had a benign adenoma. After operation, pruritus, bone pain and muscle weakness disappeared, also serum PTH and serum phosphate were declined markedly as well. After discharge, two patients (in total parathyroidectomy group) were readmitted because of postoperative hypoparathyroidism. Graft-dependent recurrence was not observed in an average follow-up of 42 months.ConclusionsTotal parathyroidectomy with sternocleidomastoid muscle trace amounts of parathyroid tissue autotransplantation is considered to be a feasible, safe and effective surgical option for the patients with sHPT.

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“…chan с соавторами из 13 гемодиализных пациентов, которым была выполнена тотальная паратиреоидэктомия по поводу вторичного гиперпаратиреоза, ни у одного из них не было выявлено переломов кости в средние сроки наблюдения 37,7 мес. [25]. В нашем исследовании рассчитан относительный риск развития осложнений с 95% ДИ при повышении уровня ПТГ и снижении витамина D 3 в сыворотке крови.…”

Section: рис 3 алгоритм периоперационного ведения пациентов получаunclassified

Mid-Term Outcomes of Primary Hip Replacement in Patients with End-Stage Chronic Renal Disease

Цед

Dulaev

Муштин

et al. 2019

Traumatology and Orthopedics of Russia

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Purpose — to evaluate mid-term outcomes of primary hip replacement in patients with end-stage chronic renal disease and to develop an algorithm for selection of surgical tactics and perioperative treatment.Materials and Methods. The authors evaluated outcomes of primary hip replacement in 45 patients receiving renal substitution therapy and 47 patients without chronic renal disease. Patients with end-stage chronic renal disease (CRD) were divided into two groups: group I included 30 (66.6%) patients receiving chronic hemodialysis (CH) and group II included 15 (33.4%) patients after renal transplantation (RT). Group III of 47 (51.1%) patients without any signs of CRD who underwent hip arthroplasty within relevant period of time was established to evaluate the effectiveness of primary hip replacement. Blood serum Ca2+ and P5+ levels as well as levels of parathyroid hormone (PTH) and 1.25-dihydroxyvitamin D were measured to determine the rate of calcium- phosphoric metabolism disturbance. Multi-spiral CT scans of hip joint were performed to identify bone mineral density and the mean Hounsfield (Hu) value was calculated for which the data was obtained from five various points on the proximal femur and acetabulum. Beta-2 microglobulin (B2M) blood test was performed to confirm amyloid bone disease.Results. The authors did not observe statistically significant differences for arthroplasty outcomes in patients of group II and III. Patients receiving long-term hemodialysis demonstrated significantly lower parameters of Harris score and Barthel’s index of social adaptation after hip replacement as compared to groups II and III: patients of group I demonstrated outcomes improvement at 19.55%, in group II — at 13.03%, in group III — at 10.15% as compared to preoperative status. Decrease of 1.25-dihydroxyvitamin D below 20,0 mcg results in resorption of cancellous bone in proximal femur and acetabulum along with myopathy of gluteus muscles. Sharp increase of parathyroid hormone level (over 600 pcg/ml) was accompanied by inhibition of osteoblasts proliferation and differentiation resulting in substantial impairment of mineralization.Conclusion. According to the algorithm suggested by the authors the key parameters that need to be evaluated in preoperative period are parathyroid hormone (PTH) and 1.25-dihydroxyvitamin D. Five-fold increase of PTH (>600 pcg/ml) demands parathyroidectomy as the first stage of treatment to decrease risk of early aseptic loosening of hip prosthesis and development of periprosthetic fracture.

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Prospective study on dialysis patients after total parathyroidectomy without autoimplant

Abstract: In the studied series of total parathyroidectomy without autoimplant, adynamic bone disease occurred in three out of seven repeat bone biopsies while improvement occurred in the rest. Bone mineral density was much improved and there was no fracture.

Cited by 11 publications

References 30 publications

Influence of Parathyroidectomy on Bone Metabolism and Bone Pain in Patients with Secondary Hyperparathyroidism

Influence of Parathyroidectomy on Bone Metabolism and Bone Pain in Patients with Secondary Hyperparathyroidism

Total parathyroidectomy with trace amounts of parathyroid tissue autotransplantation as the treatment of choice for secondary hyperparathyroidism: a single-center experience

Mid-Term Outcomes of Primary Hip Replacement in Patients with End-Stage Chronic Renal Disease

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