“Outcomes of parathyroidectomy in patients with renal hyperparathyroidism”
Abstract
ABSTRACT
OBJECTIVE
To evaluate the outcomes of chronic kidney disease (CKD) patients on renal replacement therapy with renal hyperparathyroidism (rHPT) who are undergoing parathyroidectomy.
METHODS
This is a retrospective of single-center study of CKD patients on renal replacement therapy with hyperparathyroidism undergoing operation of parathyroidectomy at Chiangrai Prachanukroh Hospital, Thailand from January 2012 to October 2022. The primary outcomes were evaluated the difference in pre-operative period and post-operative period of within 7 days, 1 month, 3 months, 6 months, and 12 months of serum PTH, calcium, and phosphate. The secondary outcomes were observed the postoperative complications and, the recurrence rate of hyperparathyroidism.
RESULTS
A total of 241 individuals were enrolled in the study. There were 219 patients (90.87%) using RRT with hemodialysis. The preoperative period, the mean serum PTH was 2,154.79±2,320.59 pg/ml with a median of 1,833 (1,375-2,411) pg/ml. The mean serum calcium was 9.66±0.94 mg/ml and, phosphate was 5.24±2.14 mg/ml. A total of 192 patients (79.67%) had performed total parathyroidectomy. There was a difference reduction in the median and mean level of serum PTH with statistically significant difference P<0.001. The serum calcium and phosphate levels were also reduced in the mean level with statistically significant difference P<0.001 with majority in the first 3 months. Post operation, there were 10 patients (4.15%) had symptoms of hypocalcemia, 4 patients (1.66%) had hoarseness and, 3 patients (1.24%) had bleeding/hematoma. There were 35 patients (14.77%) and 38 patients (16.17%) had recurrence of hyperparathyroidism after 6 and 12 months, respectively.
CONCLUSION
This study demonstrated that there were good outcomes of parathyroidectomy in CKD patients with rHPT. Surgical parathyroidectomy is one of the essential treatment options for rHPT which were safe and low complications.
References
REFERNCE.
1. Yuen NK, Ananthakrishnan S, Campbell MJ. Hyperparathyroidism of renal disease. The Permanente Journal 2016;20.
2. Renkema KY, Alexander RT, Bindels RJ, Hoenderop JG. Calcium and phosphate homeostasis: concerted interplay of new regulators. Annals of medicine 2008;40:82-91.
3. Sahota O, Mundey M, San P, Godber I, Lawson N, Hosking D. The relationship between vitamin D and parathyroid hormone: calcium homeostasis, bone turnover, and bone mineral density in postmenopausal women with established osteoporosis. Bone 2004;35:312-9.
4. Tominaga Y, Tanaka Y, Sato K, Nagasaka T, Takagi H. Histopathology, pathophysiology, and indications for surgical treatment of renal hyperparathyroidism. Seminars in surgical oncology; 1997: Wiley Online Library. p. 78-86.
5. De Boer IH, Gorodetskaya I, Young B, Hsu C-y, Chertow GM. The severity of secondary hyperparathyroidism in chronic renal insufficiency is GFR-dependent, race-dependent, and associated with cardiovascular disease. Journal of the American Society of Nephrology 2002;13:2762-9.
6. Rostand SG, Drüeke TB. Parathyroid hormone, vitamin D, and cardiovascular disease in chronic renal failure. Kidney international 1999;56:383-92.
7. Kasiske BL, Zeier MG, Chapman JR, et al. KDIGO clinical practice guideline for the care of kidney transplant recipients: a summary. Kidney international 2010;77:299-311.
8. Oltmann SC, Madkhali TM, Sippel RS, Chen H, Schneider DF. Kidney Disease Improving Global Outcomes guidelines and parathyroidectomy for renal hyperparathyroidism. journal of surgical research 2015;199:115-20.
9. Lindberg JS, Culleton B, Wong G, et al. Cinacalcet HCl, an oral calcimimetic agent for the treatment of secondary hyperparathyroidism in hemodialysis and peritoneal dialysis: a randomized, double-blind, multicenter study. Journal of the American Society of Nephrology 2005;16:800-7.
10. Rodríguez M, Goodman WG, Liakopoulos V, Messa P, Wiecek A, Cunningham J. The use of calcimimetics for the treatment of secondary hyperparathyroidism: a 10 year evidence review. Seminars in Dialysis; 2015: Wiley Online Library. p. 497-507.
11. Lau WL, Obi Y, Kalantar-Zadeh K. Parathyroidectomy in the management of secondary hyperparathyroidism. Clinical Journal of the American Society of Nephrology 2018;13:952-61.
12. Van Der Plas WY, Dulfer RR, Engelsman AF, et al. Effect of parathyroidectomy and cinacalcet on quality of life in patients with end-stage renal disease-related hyperparathyroidism: a systematic review. Nephrology Dialysis Transplantation 2017;32:1902-8.
13. Chen J, Jia X, Kong X, Wang Z, Cui M, Xu D. Total parathyroidectomy with autotransplantation versus subtotal parathyroidectomy for renal hyperparathyroidism: A systematic review and meta‐analysis. Nephrology 2017;22:388-96.
14. Liu M-E, Qiu N-C, Zha S-L, et al. To assess the effects of parathyroidectomy (TPTX versus TPTX+ AT) for Secondary Hyperparathyroidism in chronic renal failure: A Systematic Review and Meta-Analysis. International Journal of Surgery 2017;44:353-62.
15. Tang JA, Friedman J, Hwang MS, Salapatas AM, Bonzelaar LB, Friedman M. Parathyroidectomy for tertiary hyperparathyroidism: A systematic review. American journal of otolaryngology 2017;38:630-5.
16. Gasparri G, Camandona M, Abbona GC, et al. Secondary and tertiary hyperparathyroidism: causes of recurrent disease after 446 parathyroidectomies. Annals of surgery 2001;233:65.
17. Jamal SA, Miller PD. Secondary and tertiary hyperparathyroidism. Journal of Clinical Densitometry 2013;16:64-8.
18. Lim CTS, Kalaiselvam T, Kitan N, Goh BL. Clinical course after parathyroidectomy in adults with end-stage renal disease on maintenance dialysis. Clinical Kidney Journal 2018;11:265-9.
19. Konturek A, Barczyński M, Stopa M, Nowak W. Subtotal parathyroidectomy for secondary renal hyperparathyroidism: a 20-year surgical outcome study. Langenbeck's archives of surgery 2016;401:965-74.
20. Kim MS, Kim G-H, Lee CH, Park J-S, Lee JY, Tae K. Surgical outcomes of subtotal parathyroidectomy for renal hyperparathyroidism. Clinical and experimental otorhinolaryngology 2020;13:173-8.
21. Tentori F, Wang M, Bieber BA, et al. Recent changes in therapeutic approaches and association with outcomes among patients with secondary hyperparathyroidism on chronic hemodialysis: the DOPPS study. Clinical Journal of the American Society of Nephrology 2015;10:98-109.
22. Tentori F, Blayney MJ, Albert JM, et al. Mortality risk for dialysis patients with different levels of serum calcium, phosphorus, and PTH: the Dialysis Outcomes and Practice Patterns Study (DOPPS). American Journal of Kidney Diseases 2008;52:519-30.
23. Dream S, Kuo LE, Kuo JH, et al. The American Association of Endocrine Surgeons Guidelines for the definitive surgical management of secondary and tertiary renal hyperparathyroidism. Annals of surgery 2022;276:e141-e76.
24. Cabo J, Gallagher K, Baregamian N. Challenges and controversies in the surgical management of uremic hyperparathyroidism: a systematic review. The American Journal of Surgery 2018;216:713-22.
25. Mazzaferro S, Chicca S, Pasquali M, et al. Changes in bone turnover after parathyroidectomy in dialysis patients: role of calcitriol administration. Nephrology Dialysis Transplantation 2000;15:877-82.
26. Lu KC, Ma WY, Yu JC, Wu CC, Chu P. Bone turnover markers predict changes in bone mineral density after parathyroidectomy in patients with renal hyperparathyroidism. Clinical endocrinology 2012;76:634-42.
27. Rajeev P, Lee KY, Tang XJ, Goo TT, Tan WB, Ngiam KY. Outcomes of parathyroidectomy in renal hyperparathyroidism in patients with No access to renal transplantation in Singapore. Int J Surg 2016;25:64-8.
28. Liu ME, Qiu NC, Zha SL, et al. To assess the effects of parathyroidectomy (TPTX versus TPTX+AT) for Secondary Hyperparathyroidism in chronic renal failure: A Systematic Review and Meta-Analysis. Int J Surg 2017;44:353-62.
29. Liang Y, Sun Y, Ren L, Qi XW, Li Y, Zhang F. Short-term efficacy of surgical treatment of secondary hyperparathyroidism. Eur Rev Med Pharmacol Sci 2015;19:3904-9.
30. Chou F-F, Lee C-H, Chen H-Y, Chen J-B, Hsu K-T, Sheen-Chen S-M. Persistent and recurrent hyperparathyroidism after total parathyroidectomy with autotransplantation. Annals of surgery 2002;235:99.
31. Casella C, Galani A, Totaro L, et al. Total parathyroidectomy with subcutaneous parathyroid forearm autotransplantation in the treatment of secondary hyperparathyroidism: a single-center experience. International Journal of Endocrinology 2018;2018.
32. Ketteler M, Block GA, Evenepoel P, et al. Diagnosis, evaluation, prevention, and treatment of chronic kidney disease–mineral and bone disorder: Synopsis of the kidney disease: improving global outcomes 2017 clinical practice guideline update. Annals of internal medicine 2018;168:422-30.
33. Madorin C, Owen RP, Fraser WD, et al. The surgical management of renal hyperparathyroidism. European Archives of Oto-Rhino-Laryngology 2012;269:1565-76.
34. Hung K-C, Huang C-Y, Liu C-C, et al. Serum bone resorption markers after parathyroidectomy for renal hyperparathyroidism: correlation analyses for the cross-linked N-telopeptide of collagen I and tartrate-resistant acid phosphatase. The Scientific World Journal 2012;2012.
35. Kim MS, Kim GH, Lee CH, Park JS, Lee JY, Tae K. Surgical Outcomes of Subtotal Parathyroidectomy for Renal Hyperparathyroidism. Clin Exp Otorhinolaryngol 2020;13:173-8.
36. Lorenz K, Bartsch DK, Sancho JJ, Guigard S, Triponez F. Surgical management of secondary hyperparathyroidism in chronic kidney disease—a consensus report of the European Society of Endocrine Surgeons. Langenbeck's archives of surgery 2015;400:907-27.
37. Parsak CK, SARITAŞ G, Seydaoglu G, et al. Outcomes of total parathyroidectomy with autotransplantation versus subtotal parathyroidectomy with routine addition of thymectomy to both groups: single center experience of secondary hyperparathyroidism. Balkan medical journal 2014;2014:77-82.
1. Yuen NK, Ananthakrishnan S, Campbell MJ. Hyperparathyroidism of renal disease. The Permanente Journal 2016;20.
2. Renkema KY, Alexander RT, Bindels RJ, Hoenderop JG. Calcium and phosphate homeostasis: concerted interplay of new regulators. Annals of medicine 2008;40:82-91.
3. Sahota O, Mundey M, San P, Godber I, Lawson N, Hosking D. The relationship between vitamin D and parathyroid hormone: calcium homeostasis, bone turnover, and bone mineral density in postmenopausal women with established osteoporosis. Bone 2004;35:312-9.
4. Tominaga Y, Tanaka Y, Sato K, Nagasaka T, Takagi H. Histopathology, pathophysiology, and indications for surgical treatment of renal hyperparathyroidism. Seminars in surgical oncology; 1997: Wiley Online Library. p. 78-86.
5. De Boer IH, Gorodetskaya I, Young B, Hsu C-y, Chertow GM. The severity of secondary hyperparathyroidism in chronic renal insufficiency is GFR-dependent, race-dependent, and associated with cardiovascular disease. Journal of the American Society of Nephrology 2002;13:2762-9.
6. Rostand SG, Drüeke TB. Parathyroid hormone, vitamin D, and cardiovascular disease in chronic renal failure. Kidney international 1999;56:383-92.
7. Kasiske BL, Zeier MG, Chapman JR, et al. KDIGO clinical practice guideline for the care of kidney transplant recipients: a summary. Kidney international 2010;77:299-311.
8. Oltmann SC, Madkhali TM, Sippel RS, Chen H, Schneider DF. Kidney Disease Improving Global Outcomes guidelines and parathyroidectomy for renal hyperparathyroidism. journal of surgical research 2015;199:115-20.
9. Lindberg JS, Culleton B, Wong G, et al. Cinacalcet HCl, an oral calcimimetic agent for the treatment of secondary hyperparathyroidism in hemodialysis and peritoneal dialysis: a randomized, double-blind, multicenter study. Journal of the American Society of Nephrology 2005;16:800-7.
10. Rodríguez M, Goodman WG, Liakopoulos V, Messa P, Wiecek A, Cunningham J. The use of calcimimetics for the treatment of secondary hyperparathyroidism: a 10 year evidence review. Seminars in Dialysis; 2015: Wiley Online Library. p. 497-507.
11. Lau WL, Obi Y, Kalantar-Zadeh K. Parathyroidectomy in the management of secondary hyperparathyroidism. Clinical Journal of the American Society of Nephrology 2018;13:952-61.
12. Van Der Plas WY, Dulfer RR, Engelsman AF, et al. Effect of parathyroidectomy and cinacalcet on quality of life in patients with end-stage renal disease-related hyperparathyroidism: a systematic review. Nephrology Dialysis Transplantation 2017;32:1902-8.
13. Chen J, Jia X, Kong X, Wang Z, Cui M, Xu D. Total parathyroidectomy with autotransplantation versus subtotal parathyroidectomy for renal hyperparathyroidism: A systematic review and meta‐analysis. Nephrology 2017;22:388-96.
14. Liu M-E, Qiu N-C, Zha S-L, et al. To assess the effects of parathyroidectomy (TPTX versus TPTX+ AT) for Secondary Hyperparathyroidism in chronic renal failure: A Systematic Review and Meta-Analysis. International Journal of Surgery 2017;44:353-62.
15. Tang JA, Friedman J, Hwang MS, Salapatas AM, Bonzelaar LB, Friedman M. Parathyroidectomy for tertiary hyperparathyroidism: A systematic review. American journal of otolaryngology 2017;38:630-5.
16. Gasparri G, Camandona M, Abbona GC, et al. Secondary and tertiary hyperparathyroidism: causes of recurrent disease after 446 parathyroidectomies. Annals of surgery 2001;233:65.
17. Jamal SA, Miller PD. Secondary and tertiary hyperparathyroidism. Journal of Clinical Densitometry 2013;16:64-8.
18. Lim CTS, Kalaiselvam T, Kitan N, Goh BL. Clinical course after parathyroidectomy in adults with end-stage renal disease on maintenance dialysis. Clinical Kidney Journal 2018;11:265-9.
19. Konturek A, Barczyński M, Stopa M, Nowak W. Subtotal parathyroidectomy for secondary renal hyperparathyroidism: a 20-year surgical outcome study. Langenbeck's archives of surgery 2016;401:965-74.
20. Kim MS, Kim G-H, Lee CH, Park J-S, Lee JY, Tae K. Surgical outcomes of subtotal parathyroidectomy for renal hyperparathyroidism. Clinical and experimental otorhinolaryngology 2020;13:173-8.
21. Tentori F, Wang M, Bieber BA, et al. Recent changes in therapeutic approaches and association with outcomes among patients with secondary hyperparathyroidism on chronic hemodialysis: the DOPPS study. Clinical Journal of the American Society of Nephrology 2015;10:98-109.
22. Tentori F, Blayney MJ, Albert JM, et al. Mortality risk for dialysis patients with different levels of serum calcium, phosphorus, and PTH: the Dialysis Outcomes and Practice Patterns Study (DOPPS). American Journal of Kidney Diseases 2008;52:519-30.
23. Dream S, Kuo LE, Kuo JH, et al. The American Association of Endocrine Surgeons Guidelines for the definitive surgical management of secondary and tertiary renal hyperparathyroidism. Annals of surgery 2022;276:e141-e76.
24. Cabo J, Gallagher K, Baregamian N. Challenges and controversies in the surgical management of uremic hyperparathyroidism: a systematic review. The American Journal of Surgery 2018;216:713-22.
25. Mazzaferro S, Chicca S, Pasquali M, et al. Changes in bone turnover after parathyroidectomy in dialysis patients: role of calcitriol administration. Nephrology Dialysis Transplantation 2000;15:877-82.
26. Lu KC, Ma WY, Yu JC, Wu CC, Chu P. Bone turnover markers predict changes in bone mineral density after parathyroidectomy in patients with renal hyperparathyroidism. Clinical endocrinology 2012;76:634-42.
27. Rajeev P, Lee KY, Tang XJ, Goo TT, Tan WB, Ngiam KY. Outcomes of parathyroidectomy in renal hyperparathyroidism in patients with No access to renal transplantation in Singapore. Int J Surg 2016;25:64-8.
28. Liu ME, Qiu NC, Zha SL, et al. To assess the effects of parathyroidectomy (TPTX versus TPTX+AT) for Secondary Hyperparathyroidism in chronic renal failure: A Systematic Review and Meta-Analysis. Int J Surg 2017;44:353-62.
29. Liang Y, Sun Y, Ren L, Qi XW, Li Y, Zhang F. Short-term efficacy of surgical treatment of secondary hyperparathyroidism. Eur Rev Med Pharmacol Sci 2015;19:3904-9.
30. Chou F-F, Lee C-H, Chen H-Y, Chen J-B, Hsu K-T, Sheen-Chen S-M. Persistent and recurrent hyperparathyroidism after total parathyroidectomy with autotransplantation. Annals of surgery 2002;235:99.
31. Casella C, Galani A, Totaro L, et al. Total parathyroidectomy with subcutaneous parathyroid forearm autotransplantation in the treatment of secondary hyperparathyroidism: a single-center experience. International Journal of Endocrinology 2018;2018.
32. Ketteler M, Block GA, Evenepoel P, et al. Diagnosis, evaluation, prevention, and treatment of chronic kidney disease–mineral and bone disorder: Synopsis of the kidney disease: improving global outcomes 2017 clinical practice guideline update. Annals of internal medicine 2018;168:422-30.
33. Madorin C, Owen RP, Fraser WD, et al. The surgical management of renal hyperparathyroidism. European Archives of Oto-Rhino-Laryngology 2012;269:1565-76.
34. Hung K-C, Huang C-Y, Liu C-C, et al. Serum bone resorption markers after parathyroidectomy for renal hyperparathyroidism: correlation analyses for the cross-linked N-telopeptide of collagen I and tartrate-resistant acid phosphatase. The Scientific World Journal 2012;2012.
35. Kim MS, Kim GH, Lee CH, Park JS, Lee JY, Tae K. Surgical Outcomes of Subtotal Parathyroidectomy for Renal Hyperparathyroidism. Clin Exp Otorhinolaryngol 2020;13:173-8.
36. Lorenz K, Bartsch DK, Sancho JJ, Guigard S, Triponez F. Surgical management of secondary hyperparathyroidism in chronic kidney disease—a consensus report of the European Society of Endocrine Surgeons. Langenbeck's archives of surgery 2015;400:907-27.
37. Parsak CK, SARITAŞ G, Seydaoglu G, et al. Outcomes of total parathyroidectomy with autotransplantation versus subtotal parathyroidectomy with routine addition of thymectomy to both groups: single center experience of secondary hyperparathyroidism. Balkan medical journal 2014;2014:77-82.
Published
2023-07-06
How to Cite
Sirijanchune, P., Lukkraisorn, S., & Chueamuangphan, N. (2023). “Outcomes of parathyroidectomy in patients with renal hyperparathyroidism” . The Clinical Academia, 47(2), 19-26. Retrieved from https://journal.axiomlaboratory.com/index.php/theclinicalacademia/article/view/48
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