Outcomes of Surgical Parathyroidectomy in Dialysis Patients with Renal Hyperparathyroidism at Suratthani Hospital
Keywords:
Renal hyperparathyroidism, Parathyroidectomy, Hungry bone syndromeAbstract
Introduction: Chronic kidney disease results in abnormalities in mineral and hormonal balance. Hyperparathyroidism causes complications to the vascular system, bones and increase mortality. End stage kidney disease patients with renal hyperparathyroidism who do not respond to medication require parathyroidectomy if there are no contraindications. Suratthani Hospital has been performing parathyroid surgery on patients with this condition since 2010, but the data has never been analyzed before.
Objectives: To evaluate the outcomes of surgical parathyroidectomy in dialysis patients with renal hyperparathyroidism at Suratthani Hospital.
Method: This retrospective study includes patients with end-stage renal disease who were receiving dialysis, over 18 years old, had refractory renal hyperparathyroidism, and underwent parathyroidectomy at Suratthani Hospital between January 1, 2010, and December 31, 2023.
Results: A total of 216 patients underwent parathyroidectomy. 84 cases had subtotal parathyroidectomy, 73 had total parathyroidectomy with auto-transplantation, and 59 had total parathyroidectomy without auto-transplantation. Diffuse hyperplasia was found in 94.4%, while 6.9% had coexisting thyroid carcinoma. Postoperative hypocalcemia occurred in 37.7% of cases, and received intravenous calcium treatment. Preoperative alkaline phosphatase levels and corrected calcium levels were correlated with postoperative hypocalcemia. Follow-up of parathyroid hormone levels 6 months after parathyroidectomy in 195 patients revealed 48 cases of persistent hyperparathyroidism (24.6%) and 2 cases of recurrent hyperparathyroidism.
Conclusion: Surgical parathyroidectomy is an effective treatment for renal hyperparathyroidism in dialysis patients. Hypocalcemia is the main complication and requires careful evaluation and appropriate treatment.
References
KDIGO 2017 clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease–mineral and bone disorder (CKD-MBD). Kidney International Supplements. 2017;7(1):1-59.
KDIGO Clinical Practice Guideline for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease–Mineral and Bone Disorder (CKD–MBD). Kidney Int. 2009;76(Suppl 113):S1–S130.
Taïeb D, Ureña-Torres P, Zanotti-Fregonara P, Rubello D, Ferretti A, Henter I, et al. Parathyroid scintigraphy in renal hyperparathyroidism: the added diagnostic value of SPECT and SPECT/CT. Clinical nuclear medicine. 2013;38(8):630-5.
Forestalling Hungry Bone Syndrome after Parathyroidectomy in Patients with Primary and Renal Hyperparathyroidism. Diagnostics (Basel). 2023 Jun 2;13(11):1953.
Ge Y, Yang G, Wang N, Zha X, Yu X, Mao H, Sun B, Zeng M, Zhang B, Xing C. Bone metabolism markers and hungry bone syndrome after parathyroidectomy in dialysis patients with secondary hyperparathyroidism. Int Urol Nephrol. 2019;51(8):1443-1449.
Ho L-Y, Wong P-N, Sin H-K, et al. Risk factors and clinical course of hungry bone syndrome after total parathyroidectomy in dialysis patients with secondary hyperparathyroidism. BMC Nephrol. 2017;18(1):12.
Kritmetapak K, Kongpetch S, Chotmongkol W, Raruenrom Y, Sangkhamanon S, Pongchaiyakul C. Incidence of and risk factors for post-parathyroidectomy hungry bone syndrome in patients with secondary hyperparathyroidism. Renal Failure. 2020;42(1):1118-26.
Gao D, Lou Y, Cui Y, Liu S, Cui W, Sun G. Risk factors for hypocalcemia in dialysis patients with refractory secondary hyperparathyroidism after parathyroidectomy: a meta-analysis. Renal Failure. 2022;44(1):503-12.
Lee JB, Kim WY, Lee Y-M. The role of preoperative ultrasonography, computed tomography, and sestamibi scintigraphy localization in secondary hyperparathyroidism. Annals of surgical treatment and research. 2015;89(6):300-5.
Caldarella C, Treglia G, Pontecorvi A, Giordano A. Diagnostic performance of planar scintigraphy using 99m Tc-MIBI in patients with secondary hyperparathyroidism: a meta-analysis. Annals of nuclear medicine.2012;26:794-803.
Jones BA, Lindeman B, Chen H. Are Tc-99m-sestamibi scans in patients with secondary hyperparathyroidism and renal failure needed? Journal of Surgical Research.2019;243:380-3.
Preda C, Branisteanu D, Armasu I, et al. Coexistent papillary thyroid carcinoma diagnosed in surgically treated patients for primary versus secondary hyperparathyroidism: same incidence, different characteristics. BMC Surg. 2019;19(1):94.
Zhao S, Gan W, Xie W, Cao J, Zhang L, Wen P, Yang J, Mingxia. A single-center experience of parathyroidectomy in 1500 cases for secondary hyperparathyroidism: a retrospective study. Ren Fail. 2022 Dec;44(1):23-29.
Apipan P, Chindavijak S. Success rate and factors related to surgical treatment in secondary and tertiary hyperparathyroidism in chronic renal failure and the accuracy of preoperative localization. J Otolaryngol Head Neck Surg. 2019 ;44(5):217-224.
Chainapapong K. Outcome of parathyroidectomy for renal hyperparathyroidism: a single-center experience. Thai J Surg. 2022;43(1):18-25.
Rojjaratpaisarn W. Surgical outcomes for secondary and tertiary hyperparathyroidism: a 10-year study in Surin Hospital. Surin Hosp J. 2023;38(2):349-357.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Region11Medical Journal
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
