Abstract
Background
Aluminum overload and accumulation in tissues may lead to skeletal, hematological, and neurological toxicity. The aim of this study was to assess the effects of serum aluminum levels on presentations, postoperative recovery, and symptom improvement in patients undergoing parathyroidectomy for secondary hyperparathyroidism.
Methods
From 2008 to 2013, all patients with end-stage renal disease undergoing initial parathyroidectomy were included in the study. Serum aluminum level was measured preoperatively and/or within 1 week after surgery. Preoperative and postoperative biochemical profile and symptoms were compared between the low and high aluminum groups.
Results
A total of 176 patients were included in the study. Of these, 38 (22 %) patients had serum aluminum levels higher than 20 μg/L. A higher percentage of patients in the high aluminum group were on peritoneal dialysis than in the low aluminum group (24 vs. 4 %, p = 0.001). Both groups had similar bone mineral density and changes in biochemical profiles. The preoperative parathyroidectomy assessment of symptoms (PAS) score was not associated with serum aluminum levels (p = 0.349), whereas the postoperative PAS score showed positive association (p = 0.005). There was a negative association between serum aluminum levels and the improvement of total PAS scores (p = 0.001). The high aluminum group had more residual symptoms in three aspects: bone pain (p = 0.038), difficulty getting out of a chair or car (p = 0.045), and pruritus (p = 0.041).
Conclusions
A high serum aluminum level was associated with reduced symptom improvement in patients undergoing parathyroidectomy for secondary hyperparathyroidism.
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References
Kumar R, Thompson JR (2011) The regulation of parathyroid hormone secretion and synthesis. J Am Soc Nephrol 22:216–224
Cheng SP, Lee JJ, Liu TP et al (2014) Parathyroidectomy improves symptomatology and quality of life in patients with secondary hyperparathyroidism. Surgery 155:320–328
Jeffery EH, Abreo K, Burgess E et al (1996) Systemic aluminum toxicity: effects on bone, hematopoietic tissue, and kidney. J Toxicol Environ Health 48:649–665
National Kidney Foundation (2003) K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis 42:S1–S201
Kidney Disease Improving Global Outcomes (KDIGO) CKD-MBD Work Group (2009) KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD). Kidney Int Suppl 113:S1–S130
Block GA, Wheeler DC, Persky MS et al (2012) Effects of phosphate binders in moderate CKD. J Am Soc Nephrol 23:1407–1415
Jamal SA, Vandermeer B, Raggi P et al (2013) Effect of calcium-based versus non-calcium-based phosphate binders on mortality in patients with chronic kidney disease: an updated systematic review and meta-analysis. Lancet 382:1268–1277
Cheng SP, Liu CL, Chen HH et al (2009) Prolonged hospital stay after parathyroidectomy for secondary hyperparathyroidism. World J Surg 33:72–79. doi:10.1007/s00268-008-9787-2
Cheng SP, Yang TL, Lee JJ et al (2011) Gender differences among patients with secondary hyperparathyroidism undergoing parathyroidectomy. J Surg Res 168:82–87
Lopes AA, Tong L, Thumma J et al (2012) Phosphate binder use and mortality among hemodialysis patients in the dialysis outcomes and practice patterns study (DOPPS): evaluation of possible confounding by nutritional status. Am J Kidney Dis 60:90–101
Di Iorio B, Bellasi A, Russo D, INDEPENDENT Study Investigators (2012) Mortality in kidney disease patients treated with phosphate binders: a randomized study. Clin J Am Soc Nephrol 7:487–493
Lee CH, Lee YC (2003) Surgery in Taiwan. Arch Surg 138:922–927
Uribarri J (2007) Phosphorus homeostasis in normal health and in chronic kidney disease patients with special emphasis on dietary phosphorus intake. Semin Dial 20:295–301
Alfrey AC, LeGendre GR, Kaehny WD (1976) The dialysis encephalopathy syndrome. Possible aluminum intoxication. N Engl J Med 294:184–188
Ott SM, Maloney NA, Coburn JW et al (1982) The prevalence of bone aluminum deposition in renal osteodystrophy and its relation to the response to calcitriol therapy. N Engl J Med 307:709–713
Coburn JW, Norris KC (1986) Diagnosis of aluminum-related bone disease and treatment of aluminum toxicity with deferoxamine. Semin Nephrol 6(4 Suppl 1):12–21
Andress DL, Ott SM, Maloney NA et al (1985) Effect of parathyroidectomy on bone aluminum accumulation in chronic renal failure. N Engl J Med 312:468–473
O’Hare JA, Murnaghan DJ (1982) Reversal of aluminum-induced hemodialysis anemia by a low-aluminum dialysate. N Engl J Med 306:654–656
Narita I, Alchi B, Omori K et al (2006) Etiology and prognostic significance of severe uremic pruritus in chronic hemodialysis patients. Kidney Int 69:1626–1632
Manenti L, Tansinda P, Vaglio A (2009) Uraemic pruritus: clinical characteristics, pathophysiology and treatment. Drugs 69:251–263
Friga V, Linos A, Linos DA (1997) Is aluminum toxicity responsible for uremic pruritus in chronic hemodialysis patients? Nephron 75:48–53
Ketteler M, Biggar PH (2013) Use of phosphate binders in chronic kidney disease. Curr Opin Nephrol Hypertens 22:413–420
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Cheng, SP., Lee, JJ., Liu, TP. et al. Aluminum Overload Hampers Symptom Improvement Following Parathyroidectomy for Secondary Hyperparathyroidism. World J Surg 38, 2838–2844 (2014). https://doi.org/10.1007/s00268-014-2695-8
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DOI: https://doi.org/10.1007/s00268-014-2695-8