Renal dysfunction in primary hyperparathyroidism; effect of Parathyroidectomy: A retrospective Cohort Study

Nair, C. Gopalakrishnan; Babu, Merin; Jacob, Pradeep; Ramachandran, Riju; Mathew, Jacob; Unnikrishnan,

doi:10.1016/j.ijsu.2016.11.009

Cited by 24 publications

(15 citation statements)

References 25 publications

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“…5 Resolution of hyperparathyroidism by surgical resection has been demonstrated to halt the progression of or improve renal insufficiency. 6,7 Real-time intraoperative PTH (IOPTH) monitoring has been invaluable for assessing parathyroid function during minimally invasive parathyroidectomy. 8,9 Numerous IOPTH criteria exist in the literature, and their use varies by institution.…”

Section: Introductionmentioning

confidence: 99%

The effect of chronic kidney disease on intraoperative parathyroid hormone: A linear mixed model analysis

Graves

Hwang

McManus

et al. 2021

Surgery

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Background: Reduced creatinine clearance is an indication for surgery in asymptomatic primary hyperparathyroidism, and a significant proportion of patients undergoing parathyroidectomy have chronic kidney disease. The purpose of this study was to evaluate the kinetics of intraoperative parathyroid hormone decline during parathyroidectomy in patients who have chronic kidney disease compared with those with who have normal renal function. Methods: This is a single-center, retrospective study of patients with primary hyperparathyroidism undergoing parathyroidectomy (n ¼ 646). Patients were grouped based on estimated glomerular filtration rate greater than (normal renal function) or less than (chronic kidney disease) 60 mL/min/ 1.73m 2 . All patients had intraoperative parathyroid hormone monitoring and 6-month postoperative serum studies to confirm surgical cure. Intraoperative parathyroid hormone kinetic curves were analyzed using a linear mixed model. Results: Despite similar pre-excision values, patients with chronic kidney disease had significantly higher intraoperative parathyroid hormone values at 5 minutes (76 vs 58 pg/mL, P ¼ .02) and 10 minutes (54 vs 37 pg/mL, P ¼ .004) postexcision. No significant difference was observed in whether patients met Miami criterion by 5 minutes (chronic kidney disease 71%, normal renal function 78%, P ¼ .255) or by 10 minutes (chronic kidney disease 95%, normal renal function 96%, P ¼ .751) postexcision. Using a linear mixed model, glomerular filtration rate did not have a significant effect on the change in intraoperative parathyroid hormone over time. Conclusion:Patients with chronic kidney disease had significantly higher postexcision intraoperative parathyroid hormone levels. However, renal function did not affect the change in intraoperative parathyroid hormone over time, nor did renal function ultimately affect the likelihood of meeting the Miami criterion. Intraoperative parathyroid hormone monitoring remains useful in this population, although additional time points may be needed to observe normalization of values.

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Section: Introductionmentioning

confidence: 99%

The effect of chronic kidney disease on intraoperative parathyroid hormone: A linear mixed model analysis

Graves

Hwang

McManus

et al. 2021

Surgery

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“…In the pre‐ and postoperative assessment of PHPT patients, there was a significant improvement in creatinine values and eGFR levels in patients with renal manifestations (RM+ve); however, no change was observed in patients without renal manifestations. Most of the retrospective studies in an attempt to see the change in course of renal impairment after surgical cure reported the prevention of renal function deterioration in subset of patients only or no improvement over the period of time 28‐32 . Nair et al reported improvement in renal function in a small subset of PHPT patients (13 out of 42; 29.5%) with renal dysfunction in postparathyroidectomy period 31 .…”

Section: Discussionmentioning

confidence: 99%

“…Most of the retrospective studies in an attempt to see the change in course of renal impairment after surgical cure reported the prevention of renal function deterioration in subset of patients only or no improvement over the period of time 28‐32 . Nair et al reported improvement in renal function in a small subset of PHPT patients (13 out of 42; 29.5%) with renal dysfunction in postparathyroidectomy period 31 . Rowlands et al showed no improvement in renal function even after 4‐5 years of follow‐up 32 .…”

Section: Discussionmentioning

confidence: 99%

A detailed appraisal of renal manifestations in primary hyperparathyroidism from Indian PHPT registry: Before and after curative parathyroidectomy

Agrawal

Arya

Sood

et al. 2020

Clinical Endocrinology

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Background Primary hyperparathyroidism (PHPT) is a systemic disorder characterized by hypercalcaemia and inappropriately elevated parathyroid hormone (PTH). Renal manifestations are one of the main presenting features both in symptomatic and asymptomatic PHPT patients. Objectives We aimed to compare demographic, clinical and biochemical parameters of PHPT patients with and without renal manifestations and also analysed the influence of curative parathyroidectomy on renal functions. Methods We retrospectively analysed the data of PHPT patients from the last 25 years (1995‐ March 2019) and compared the demographic and clinical presentation and biochemical measurements between patients with and without renal manifestations and evaluated the changes in renal functions after 1 year of curative parathyroidectomy. Results Of the total 544 PHPT patients, 299 (55%) including 91 out of 141 (65%) males had renal manifestations. Among renal manifestations, nephrolithiasis and nephrocalcinosis were found in 41.7% and 27.6% PHPT patients, respectively. PHPT patients with renal manifestations had significantly higher creatinine (109.7 vs 79.6 µmol/L; P < .0001) and lower eGFR level (78.8 vs 93.9 mL/min/1.73 m2; P < .0001) compared to patients without renal manifestations. Parathyroidectomy resolved the clinical symptoms with biochemical cure in the patients from both the groups. Patients with renal manifestations showed improvement in creatinine and eGFR levels after 1 year of curative parathyroidectomy; however, patients without renal manifestations showed no change in creatinine and eGFR levels. Conclusion Young age and male gender are predictors of renal manifestations in PHPT. Curative parathyroidectomy improves renal functions in PHPT patients with renal manifestations compared to PHPT patients without renal manifestation.

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“…Severe hypercalcemia and/or rapidly rising serum Ca levels cause a reduction in eGFR 11 . In patients with primary hyperparathyroidism, hypercalcemia causes renal dysfunction by multiple mechanisms such as hypercalciuria, nephrolithiasis, and nephrocalcinosis 12 . Further, overtreatment for hypocalcemia caused by hypoparathyroidism induces kidney dysfunction by hypercalciuria, because its standard treatment is not parathyroid hormone (PTH) replacement but supplementation of vitamin D analogs and Ca 13 .…”

Section: Introductionmentioning

confidence: 99%

Lower serum calcium levels are a risk factor for a decrease in eGFR in a general non-chronic kidney disease population

Mizushiri

Daimon

Murakami

et al. 2018

Sci Rep

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Association between serum calcium (Ca) levels and kidney dysfunction progression in a non-chronic kidney disease (CKD) population has not been well elucidated, especially in consideration for classical metabolic risk conditions such as hypertension, dyslipidemia, and diabetes, and those related to Ca metabolism. Among participants of the population-based Iwaki study of Japanese people, those with an estimated glomerular filtration rate (eGFR) ≧60 ml/min/1.73 m2 and age ≧40 years, and who attended the study consecutively in 2014 and 2015 were enrolled (gender (M/F): 218/380; age: 58.9 ± 10.2). Regression analysis showed a significant correlation between serum Ca levels and a change in eGFR in the 1-year period (∆eGFR) after adjustment with multiple factors including those related to Ca metabolism (β = 0.184, p < 0.001). When subjects were stratified into tertiles based on their serum Ca levels (higher >9.6 mg/dL, middle 9.4–9.6 mg/dL, lower <9.4 mg/dL), lower serum Ca levels were a significant risk for a rapid decliner of eGFR designated as the lower one third of ∆eGFR (<−4.40 ml/min/1.73 m2) (odds ratio 2.41, 95% confidence interval 1.47–3.94). Lower serum Ca levels are a significant risk for rapid decrease in eGFR, independent of previously reported metabolic risk factors in this general population with non-CKD, or eGFR ≧60 ml/min/1.73 m2.

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Renal dysfunction in primary hyperparathyroidism; effect of Parathyroidectomy: A retrospective Cohort Study

Cited by 24 publications

References 25 publications

The effect of chronic kidney disease on intraoperative parathyroid hormone: A linear mixed model analysis

The effect of chronic kidney disease on intraoperative parathyroid hormone: A linear mixed model analysis

A detailed appraisal of renal manifestations in primary hyperparathyroidism from Indian PHPT registry: Before and after curative parathyroidectomy

Lower serum calcium levels are a risk factor for a decrease in eGFR in a general non-chronic kidney disease population

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