Surgery for Renal Hyperparathyroidism in the Era of Cinacalcet: A Single-Center Experience

Abstract

Background and Aims: There are only few data on the influence of cinacalcet on the outcome of parathyroidectomy in patients with renal hyperparathyroidism. Indication and timing of surgery have changed since its introduction, especially with regard to kidney transplantation. Therefore, we retrospectively analyzed patients undergoing parathyroidectomy for renal hyperparathyroidism in our institution. Material and methods: Between 2008 and 2015, 196 consecutive operations in 191 patients were analyzed. About 80 operations (41%) were performed in patients receiving cinacalcet compared with 116 operations (59%) in patients without cinacalcet. Clinical data, preoperative medication, pre- and postoperative laboratory values, type and details of surgery including complications, as well as cardiovascular complications and kidney transplantation with graft function were recorded. Results: Demographical data were similar in patients with or without cinacalcet treatment. A total of 54% of patients received a kidney graft before or after parathyroidectomy. Pre- and postoperative parathormone levels were similar in both groups (preoperatively 755 vs 742 ng/L, postoperatively 50 vs 46 ng/L, p > 0.10), whereas patients with cinacalcet showed significantly lower calcium levels preoperatively (2.28 vs 2.41 mmol/L, p = 0.0002). There was no difference in recurrence or persistence of hyperparathyroidism, duration of surgery, hospital stay, or complication rate. Creatinine levels in patients with tertiary hyperparathyroidism were similar after 1-year follow-up. Conclusion: Cinacalcet did not influence outcome of patients with parathyroidectomy for renal hyperparathyroidism and can be safely offered to patients not responding to medical treatment.

Risk factors of recurrent secondary hyperparathyroidism after adequate primary surgical treatment

“…While calcimimetics reduced the need for parathyroidectomy in patients with SHPT, all-cause or cardiovascular mortality did not decrease (5, 6, 18). Therefore, parathyroidectomy currently still plays a role in the era of calcimimetics, especially for patients who are refractory to medical treatment (19).…”

Pre‐operative Cinacalcet Administration Reduces Immediate Post‐operative Hypocalcemia Following Total Parathyroidectomy in Severe Renal Hyperparathyroidism

“…As these patients were at higher risks of severe renal osteodystrophy and also higher risks for post-operative hypocalcemia [18,19,[24][25][26][27][28], we believe the benefits of pre-operative. Cinacalcet would be more readily demonstrated in them, as opposed to other reports that included milder RHPT patients with lower PTH levels and therefore negative results [17,22]. Our study also adopted a strict protocol of peri-operative calcium and vitamin D supplementation as a merit in controlling for confounders.…”

“…The consequent more severe hungry bone syndrome was likely the result of more severe RHPT, rather than an effect of Cinacalcet itself [17]. Other reports showed no alteration in post-operative hypocalcemia with Cinacalcet use [16,22]. However, these reports evaluated patients with less severe RHPT (lower PTH levels) and also lack information on PTH levels before Cinacalcet administration [16,22,23], making it difficult to assess the true effect of lowering PTH with Cinacalcet on post-operative calcium kinetics.…”

“…Other reports showed no alteration in post‐operative hypocalcemia with Cinacalcet use [16, 22]. However, these reports evaluated patients with less severe RHPT (lower PTH levels) and also lack information on PTH levels before Cinacalcet administration [16, 22, 23], making it difficult to assess the true effect of lowering PTH with Cinacalcet on post‐operative calcium kinetics. Moreover, the extent of parathyroidectomy performed was heterogeneous.…”

Treatment of mineral-bone disorders in chronic kidney disease

“…Показано, что цинакальцет снижает уровень ПТГ и улучшает кальций-фосфорный гомеостаз у пациентов с неконтролируемым вторичным гиперпаратиреозом, получающих лечение программным гемодиализом [43]. В экспериментальных исследованиях изучалось влияние эвокальцета на эктопическую кальцификацию и гиперплазию ОЩЖ [44]. Установлено, что эвокальцет предотвращал кальцификацию аорты, сердца и почек, а также уменьшал размеры клеток ОЩЖ.…”