Open AccessParathyroidectomy for dialysis patients in the era of calcimimetics: The surgeons’ point of view
Author(s) -
ChenHsen Lee,
Jui-Yu Chen,
Po-Chung Kuo,
WeiTing Chen
Publication year - 2022
Publication title -
journal of the chinese medical association
Language(s) - English
Resource type - Journals
eISSN - 1728-7731
pISSN - 1726-4901
DOI - 10.1097/jcma.0000000000000694
Subject(s) - medicine , parathyroidectomy , contraindication , secondary hyperparathyroidism , dialysis , cinacalcet , hyperparathyroidism , parathyroid hormone , urology , surgery , intensive care medicine , pathology , alternative medicine , calcium
Calcimimetics is a new drug for lowering serum parathyroid hormone (PTH), calcium and phosphate in patients with hyperparathyroidism (HPT) on long-term dialysis. It became available on market in 2006. The impact of calcimimetics on the treatment by parathyroidectomy (PTx) was reviewed from the surgeons' point of view. Cure of renal HPT by calcimimetics is not feasible, but calcimimetics can improve preoperative cardiac ventricle ejection fractions by lowering serum PTH. Heart failure is not necessarily a contraindication for PTx. PTx should be done before irreversible organ damage occurs. Limb gangrenes is an ominous sign and should be prevented by frequent checkup for peripheral arterial circulation. The impact of renal osteodystrophy on the quality of life and as indirect cause of mortality deserves more attention in patients with renal HPT. Delayed referral to PTx leads to more complicated patients. A consensus between nephrologists and surgeons about propitious timing for PTx is necessary. Future prospect on the surgical treatment of renal HPT is proposed. Supplemental figure; http://links.lww.com/ASAIO/A782.