Long-term outcomes following “presumed” total parathyroidectomy for secondary hyperparathyroidism of chronic kidney disease

Conzo, Giovanni and Perna, Alessandra and Candela, Giancarlo and Palazzo, Antonietta and Parmeggiani, Domenico and Napolitano, Salvatore and Esposito, Daniela and Cavallo, Franco and Docimo, Giovanni and Santini, Luigi (2012) Long-term outcomes following “presumed” total parathyroidectomy for secondary hyperparathyroidism of chronic kidney disease. Il giornale di chirurgia, 33 (11/12). pp. 379-382. ISSN 1971-145X

Preview

Text article(94).pdf - Published Version Download (653kB)

Abstract

Aim. The most efficacious surgical treatment for renal hyperparathyroidism is still subject of research. Considering its low incidence rate of long-term relapse, “presumed” total parathyroidectomy without autotrasplantation (TP) may be indicated for secondary hyperparathyroidism (2HPT) in patients with chronic kidney disease (CKD), not eligible for kidney transplantation. The aim of this study was to analyse the TP long-term results in 2HPT haemodialysis (HD) patients. Method. Between January 2004 and October 2009, 25 2HPT HD patients, not eligible for kidney transplantation, underwent TP of at least four parathyroid glands. Clinical status and intact parathyroid hormone (iPTH) serum levels were assessed intraoperatively and during a 36-month follow-up. Results. TP improved the typical clinical symptoms and a significant reduction of iPTH serum levels was achieved in each patient. Aparathyroidism was never observed; in case of severe postoperative hypocalcemia, hypocalcemic seizures were never reported and the long-term recurrence rate was 8%. Only one patient received a kidney transplantation. Postoperative cardiovascular events (hypertension, peripheral artery disease, arrhythmia, coronary or cerebrovascular disease) were observed in 32% of cases and mortality rate was 16%. Conclusions. Considering its low long-term relapse rate and the absence of postoperative aparathyroidism, TP may still be considered the treatment of choice in patients with aggressive forms of 2HPT or of advanced dialytic vintage, with no access to renal transplantation. In case of postoperative hypoparathyroidism, hypocalcaemia can be effectively managed by medical treatment.

Item Type:	Article
Uncontrolled Keywords:	Total parathyroidectomy - Secondary hyperparathyroidism - Haemodialysis - Aparathyroidism
Subjects:	600 Tecnologia - Scienze applicate > 610 Medicina e salute (Classificare qui la tecnologia dei servizi medici) > 617 Rami vari della medicina; Chirurgia 600 Tecnologia - Scienze applicate > 610 Medicina e salute (Classificare qui la tecnologia dei servizi medici) > 617 Rami vari della medicina; Chirurgia > 617.4 Chirurgia secondo il Sistema e Regioni
Depositing User:	Nadia Del Gobbo
Date Deposited:	03 Aug 2016 15:57
Last Modified:	03 Aug 2016 15:57
URI:	http://eprints.bice.rm.cnr.it/id/eprint/8234

Actions (login required)

View Item