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Targeted surgical parathyroidectomy in end‐stage renal disease patients and long‐term metabolic control: A single‐center experience in the current era
Author(s) -
Fülöp Tibor,
Koch Christian A.,
Farah Musa Abdeen R.,
Clark Christopher M.,
Gharaibeh Kamel A.,
Lengvársky Zsolt,
Hamrahian Mehrdad,
Pitman Karen T.,
Dixit Mehul P.
Publication year - 2018
Publication title -
hemodialysis international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.658
H-Index - 47
eISSN - 1542-4758
pISSN - 1492-7535
DOI - 10.1111/hdi.12639
Subject(s) - medicine , parathyroidectomy , urology , parathyroid gland , cinacalcet , parathyroid hormone , cohort , end stage renal disease , vitamin d and neurology , retrospective cohort study , secondary hyperparathyroidism , hemodialysis , surgery , gastroenterology , calcium
Background : The long‐term results of surgical parathyroidectomy (PTX) in end‐stage renal disease (ESRD) patients are less well known in the modern era of newer activated vitamin‐D analogs, calcimimetics and intraoperative monitoring of parathyroid hormone (PTH). Methods : We performed a retrospective chart review of all ESRD patients undergoing PTX at the University of Mississippi Medical Center between January 2005 and August 2011, with follow‐up data as available up to 4 years. All PTXs were performed with intraoperative second‐generation PTH monitoring and targeted gland size reduction. Results : The cohort (N = 37) was relatively young with a mean (±SD) age of 48.4 ± 13.9. 94.6% of the subjects were African American and 59.5% female. Preoperatively, 45.9% received cinacalcet (CNC) at a mean dose of 63.5 ± 20.9 mg. The size of the largest removed glands measured 1.7 ± 0.8 cm and almost all (94.6%) glands had hyperplasia on histology. The mean length of inpatient stay was 5.5 ± 2.4 days. Preoperative calcium/phosphorus measured 9.6 ± 1.2/6.6 ± 1.7 mg/dL with PTH concentrations of 1589 ± 827 pg/mL. Postoperative PTH values measured 145.4 ± 119.2 pg/mL. Preoperative PTH strongly correlated (P < 0.0001) with both alkaline phosphatase (ALP) levels (r: 0.596) and the number of inpatient days (r: 0.545), but not with CNC administration. Independent predictors for the duration of hospitalization were preoperative ALP (beta 0.469; P = 0.001) and age (beta −0.401; P = 0.005) (R 2 0.45); for postoperative hypocalcemia, age (beta: −0.321; P = 0.006) and preoperative PTH (beta: 0.431; P = 0.036) were significant in linear regression models with stepwise selection. Conclusion : Gland‐sparing PTX achieved acceptable control of ESRD‐associated hyperparathyroidism in most patients from a socioeconomically challenged, underserved population of the United States.