Masafumi Fukagawa1, Tadao Akizawa2. 1. Division of Nephrology and Kidney Center , Kobe University School of Medicine , Kobe. 2. Division of Nephrology , Showa University School of Medicine , Tokyo , Japan.
Secondary hyperparathyroidism is one of the most important abnormalities in chronic kidney disease-mineral and bone disorder (CKD-MBD). Despite the recent development of therapeutic modalities including new phosphate binders, new vitamin D analogues and cinacalcet, many patients with very severe hyperparathyroidism still remain uncontrollable. Several studies have demonstrated that such refractory patients have markedly enlarged parathyroid glands with nodular hyperplasia composed of cells with decreased numbers of vitamin D and calcium-sensing receptors [1].Percutaneous ethanol injection therapy (PEIT) of parathyroid glands was originally developed as an alternative to conventional surgical parathyroidectomy in Europe during the 1980s. Together with the advances in imaging techniques allowing identification of the glands to be destroyed, this therapy became a more sophisticated and practical therapeutic modality to control severe hyperparathyroidism during the early 1990s in Japan [2]. In this ‘selective PEIT’, glands with nodular hyperplasia are destroyed by ethanol injection, and remaining glands with diffuse hyperplasia are controlled by subsequent medical therapy. Analysis of the prognosis of parathyroid function following these procedures clearly suggests that patients with one nodular gland were best suited to selective PEIT [3].The Japanese Society for Parathyroid Intervention, originally named as the Japanese Society for PEIT of Parathyroid, was established in 1996. The initial purpose of this society was to standardize the indication and protocol of PEIT. As a result, we published clinical guidelines for PEIT in 2003 [4] and PEIT of parathyroid has been officially covered by health insurance since 2004. We have also established another technology, direct vitamin D injection therapy, which has also been covered as an Advanced Medical Technology since 2003 in Japan.This supplemental issue of NDT Plus summarizes data and experiences on parathyroid intervention and on the pathogenesis of parathyroid hyperplasia, and a new version of the guidelines is presented.We hope that parathyroid intervention will be more widely accepted as an effective and safe therapy for severe hyperparathyroidism in CKDpatients.Conflict of interest statement. None declared.