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Impact of parathyroidectomy on neutrophil cytosolic calcium in chronic kidney disease patients: a prospective parallel group trial
Author(s) -
DEICHER R.,
KIRSCH B.,
MÜLLNER M.,
KACZIREK K.,
NIEDERLE B.,
HÖRL W. H.
Publication year - 2005
Publication title -
journal of internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.625
H-Index - 160
eISSN - 1365-2796
pISSN - 0954-6820
DOI - 10.1111/j.1365-2796.2005.01508.x
Subject(s) - parathyroidectomy , medicine , cohort , prospective cohort study , kidney disease , secondary hyperparathyroidism , hyperparathyroidism , gastroenterology , endocrinology , parathyroid hormone , urology , surgery , calcium
. Objectives. Polymorphonuclear leucocytes (PMNs) of chronic kidney disease (CKD) patients display elevated basal cytosolic calcium concentrations (iCa 2+ ). As parathyroid hormone is considered to substantially contribute to the inappropriate cellular entry of calcium in uraemia, we hypothesized that parathyroidectomy lowers PMN iCa 2+ . Design and setting. Prospective parallel group trial at a tertiary care centre. Subjects, intervention and main outcome measures. Two patient cohorts (cohort 1: 14 CKD patients; cohort 2: 14 renal transplant recipients) underwent parathyroidectomy for uncontrolled secondary hyperparathyroidism. We assessed PMN iCa 2+ (primary objective) spectrofluorimetrically 1 day before and 20 days after intervention (secondary objective: PMN glucose uptake). Data were compared with those of 16 matched maintenance haemodialysis patients (cohort 3), and to 15 healthy subjects (cohort 4), by generalized estimating equations. Results. PMN iCa 2+ of cohort 1 decreased over time and was significantly higher than that of cohort 3 before but not after parathyroidectomy [mean difference before/after parathyroidectomy: 19.1nmol L −1 (95% confidence interval: 9.4–22.4), P =0.0003/−3.2 (−20.9–14.5), P = 0.71]. PMN iCa 2+ of cohort 2 decreased over time, but we found no significant difference in comparison with cohort 3 [mean difference before/after parathyroidectomy: 6.5 nmol L −1 (−9.4–22.4), P = 0.4/−15.8 (−43.6–12.0), P = 0.25]. PMN iCa 2+ of all CKD patients was substantially higher in comparison with that of healthy subjects [cohort 4 vs. 3: −35.3 (−48.9–21.6), P < 0.001]. PMN glucose uptake increased significantly in both interventional cohorts in comparison with cohort 3. Conclusions. Parathyroidectomy lowers, but does not normalize PMN iCa 2+ of CKD patients. Further variables, possibly uraemic retention solutes, control both PMN iCa 2+ and functional responses.