Diana Moldovan1,2, Simona Racasan3, Ina Maria Kacso4, Crina Rusu4, Alina Potra4, Cosmina Bondor5, Ioan Mihai Patiu3, Mirela Gherman-Căprioară4. 1. Department of Nephrology, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania. dnmoldovan@yahoo.com. 2. Emergency County Hospital, "Mihai Manasia" Nephrology and Dialysis Clinic, 3-5 Clinicilor Street, Cluj- Napoca, Romania. dnmoldovan@yahoo.com. 3. Nefromed Dialysis Center, Cluj-Napoca, Romania. 4. Department of Nephrology, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania. 5. Department of Statistics, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania.
Abstract
INTRODUCTION: The life for end-stage renal disease patients has remarkably improved in the last years. Although mineral and bone disorders remain as unsolved complication, in severe secondary hyperparathyroidism (sHPT), the ultimate treatment is parathyroidectomy (PTX). It is an old treatment, but there are still insufficient data regarding survival after PTX. The study goals were to compare 2-year mortality and morbidity after PTX in surgically versus medically treated sHPT and to compare the efficacy and safety in subtotal versus total PTX in a cohort of patients receiving hemodialysis (HD). METHODS: This prospective, longitudinal study was carried out on a cohort of chronic HD patients with severe sHPT (iPTH over 700 pg/ml). Among the overall HD population, 26 patients underwent PTX. This group was compared to a control group treated with specific drugs. Laboratory parameters, specific symptoms and mortality were registered after 24 months of follow-up for each group. The subgroups of subtotal and total PTX patients were also compared. RESULTS: All average values of mineral markers were significantly reduced after PTX, as a proof that surgical treatment was effective. The reduction in mineral markers and the improvement in symptoms and mortality rates were similar after total and subtotal PTX. Bone pain was significantly lower in patients after PTX than in those drug treated (p = 0.0005), but not muscle weakness and itching. Survival at 2 years was better in patients surgically treated (PTX) despite significantly higher mean baseline values of iPTH, Ca and ALP compared to patients medically treated (p = 0.03). CONCLUSIONS: We compared clinical and laboratory outcomes in HD patients with severe sHPT. Mortality, bone pain and mineral markers were improved by PTX. Total and subtotal PTX had similar clinical outcomes.
INTRODUCTION: The life for end-stage renal diseasepatients has remarkably improved in the last years. Although mineral and bone disorders remain as unsolved complication, in severe secondary hyperparathyroidism (sHPT), the ultimate treatment is parathyroidectomy (PTX). It is an old treatment, but there are still insufficient data regarding survival after PTX. The study goals were to compare 2-year mortality and morbidity after PTX in surgically versus medically treated sHPT and to compare the efficacy and safety in subtotal versus total PTX in a cohort of patients receiving hemodialysis (HD). METHODS: This prospective, longitudinal study was carried out on a cohort of chronic HDpatients with severe sHPT (iPTH over 700 pg/ml). Among the overall HD population, 26 patients underwent PTX. This group was compared to a control group treated with specific drugs. Laboratory parameters, specific symptoms and mortality were registered after 24 months of follow-up for each group. The subgroups of subtotal and total PTXpatients were also compared. RESULTS: All average values of mineral markers were significantly reduced after PTX, as a proof that surgical treatment was effective. The reduction in mineral markers and the improvement in symptoms and mortality rates were similar after total and subtotal PTX. Bone pain was significantly lower in patients after PTX than in those drug treated (p = 0.0005), but not muscle weakness and itching. Survival at 2 years was better in patients surgically treated (PTX) despite significantly higher mean baseline values of iPTH, Ca and ALP compared to patients medically treated (p = 0.03). CONCLUSIONS: We compared clinical and laboratory outcomes in HDpatients with severe sHPT. Mortality, bone pain and mineral markers were improved by PTX. Total and subtotal PTX had similar clinical outcomes.
Authors: Melanie Goldfarb; Stephan S Gondek; Susan M Lim; Josephina C Farra; Vania Nose; John I Lew Journal: World J Surg Date: 2012-06 Impact factor: 3.352
Authors: Anthony J Bleyer; John Burkart; Michael Piazza; Gregory Russell; Michael Rohr; J Jeffrey Carr Journal: Am J Kidney Dis Date: 2005-09 Impact factor: 8.860
Authors: Dana Miskulin; Jennifer Bragg-Gresham; Brenda W Gillespie; Francesca Tentori; Ronald L Pisoni; Hocine Tighiouart; Andrew S Levey; Friedrich K Port Journal: Clin J Am Soc Nephrol Date: 2009-09-24 Impact factor: 8.237
Authors: Andrea Trombetti; Catherine Stoermann; John H Robert; François R Herrmann; Pietra Pennisi; Pierre-Yves Martin; René Rizzoli Journal: World J Surg Date: 2007-05 Impact factor: 3.352