Total parathyroidectomy with forearm auto-transplantation improves the quality of life and reduces the recurrence of secondary hyperparathyroidism in chronic kidney disease patients

Abstract

Background:Our study aims to explore the effect of total parathyroidectomy (PTX) with forearm autotransplantation (FAT) on the quality of life and recurrence of secondary hyperparathyroidism (SHPT) in chronic kidney disease patients.Methods:A total of 104 chronic kidney disease patients with SHPT were enrolled and divided into the PTX (n = 62) and PTX + FAT (n = 42) groups. The operation efficacy was evaluated by analyzing preoperative and postoperative values, including levels of intact parathyroid hormone (iPTH), serum phosphorus, serum calcium, alkaline phosphatase (ALP), calcium-phosphorus product, signs and symptoms, and MOS 36-item short-form health survey (SF-36) scores. Moreover, complications and recurrences were followed up for 12 months after the operation. Binary logistic regression was to present the risk factors for the recurrence of chronic kidney disease patients with SHPT.Results:Compared with the preoperative values, the PTX and PTX + FAT groups showed decrease postoperative levels of iPTH, serum phosphorus, serum calcium, calcium-phosphorus product, bone pain, and skin pruritus at all time periods. The PTX and PTX + FAT groups demonstrated decreased ALP, fracture or deformity, and coronary artery calcification at 1 month, decreased short stature at 3 months after the operation but increased SF-36 score after operation. Compared with the PTX group, the level of iPTH decreased and the levels of serum calcium, calcium-phosphorus product increased at 3, 6, and 12 months after the operation in the PTX + FAT group. The levels of ALP, fracture or deformity, short stature, and SF-36 decreased separately at 1 week and 6 and 12 months after the operation, along with the decrease of coronary artery calcification and the recurrence rate, respectively, at 6 and 12 months after the operation in the PTX + FAT group when compared with those in the PTX group. Logistic regression analysis evidenced that the preoperative iPTH level, SF-36 score, and operation type were the risk factors for the recurrence of chronic kidney disease with SHPT.Conclusion:Total PTX combined with FAT is more effective in improving the quality of life and reducing the recurrence of chronic kidney disease with SHPT than PTX alone.

Evaluation of laboratory parameters and symptoms after parathyroidectomy in dialysis patients with secondary hyperparathyroidism

“…Although T-PTX can reduce the recurrence rate, the lower level of iPTH may lead to hypoparathyroidism [48]. Some studies recommend PTX þ AT as a surgical treatment for SHPT [49,50]. Because of sample size of our research subjects, it is not yet possible to draw the conclusion of which surgical method is the best.…”

Effects of Parathyroidectomy on Plasma iPTH and (1–84) PTH Levels in Patients with Stage 5 Chronic Kidney Disease

“…Nowadays, the third-generation (1-84)PTH assay, with a fully automatic electrochemiluminescence immunoassay (ECLIA), is used clinically [12]. Many studies have shown that (1-84)PTH or a PTH ratio, such as (1-84)PTH/iPTH or (1-84)PTH/(7-84)PTH, are superior to single iPTH values for evaluating bone turnover in CKD patients, predicting the effectiveness of PTX, and estimating the fatality rate among hemodialysis patients [13][14][15][16].…”

Parathyroid Hormone Fragments: New Targets for the Diagnosis and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder

“…Some studies are showing that (1-84)PTH or the PTH ratio, such as (1-84)PTH/iPTH and (1-84)PTH/(7-84)PTH, are superior to single iPTH values for evaluating bone turnover in CKD patients, predicting the effectiveness of PTX, and estimating the fatality rate among hemodialysis patients [24, 28, 37, 38]. It was reported that higher (1-84)PTH/iPTH ratio, but not serum (1-84)PTH and iPTH, predicted higher all-cause mortality in male hemodialysis patients [28].…”