Advertisement

World Journal of Surgery

, Volume 42, Issue 2, pp 425–430 | Cite as

Development of Severe Hyperparathyroidism Despite Short-Term Renal Replacement Therapy

  • Manabu Okada
  • Yoshihiro Tominaga
  • Takahisa Hiramitsu
  • Toshihiro Ichimori
Original Scientific Report
  • 118 Downloads

Abstract

Background

We occasionally experience cases of severe secondary hyperparathyroidism (SHPT) that require parathyroidectomy (PTX) despite undergoing short-term renal replacement therapy (RRT). Because the characteristics of such cases have never been discussed, we aimed to elucidate the pathophysiology of severe SHPT after short-term RRT by retrospectively analyzing clinical data.

Methods

A total of 1013 patients with severe SHPT underwent PTX between January 2007 and April 2016 at Nagoya Daini Red Cross Hospital. Of these patients, 570 underwent RRT for ≥10 years (long RRT group) and 23 for ≤1 year (short RRT group). We retrospectively investigated and compared patient characteristics, preoperative data, subjective symptoms, and bone lesion incidence between the two groups.

Results

A higher proportion of subjects with congenital or hereditary diseases as primary disease for chronic kidney disease (CKD) (21.7% (5/23) vs. 6.3% (36/570); P = 0.016) and longer predialysis period (21.2 ± 14.0 vs. 10.1 ± 9.2 years; P < 0.001) were observed in the short RRT group than in the long RRT group. Furthermore, lower serum calcium and phosphate levels, heavier parathyroid glands, and severe bone lesions were observed in the short RRT group than in the long RRT group.

Conclusion

Severe SHPT after short-term RRT appeared to occur because of long-term CKD before initiating RRT. Therefore, treating mineral and bone disorders during the early CKD stage might prevent severe SHPT development before initiating RRT.

Notes

Acknowledgements

The authors thank Ms. Sayoko Itou and Ms. Naoko Imai for valuable sample collection and Enago (www.enago.jp) for the English language review.

Compliance with ethical standards

Conflict of interest

The authors declare no conflicts of interests.

References

  1. 1.
    Block GA, Klassen PS, Lazarus JM et al (2004) Mineral metabolism, mortality, and morbidity in maintenance hemodialysis patients. J Am Soc Nephrol 15:2208–2218CrossRefPubMedGoogle Scholar
  2. 2.
    Stevens LA, Djurdjev O, Cardew S et al (2004) Calcium, phosphate, and parathyroid hormone levels in combination and as a function of dialysis duration predict mortality: evidence for the complexity of the association between mineral metabolism and outcomes. J Am Soc Nephrol 15:770–779CrossRefPubMedGoogle Scholar
  3. 3.
    Block GA, Shearon EH, Levin NW et al (1998) Association of serum phosphorus and calcium × phosphate product with mortality risk in chronic hemodialysis patients: a national study. Am J Kidney 31:607–617CrossRefGoogle Scholar
  4. 4.
    Block GA, Port FK (2000) Re-evaluation of risks associated with hyperphosphatemia and hyperparathyroidism in dialysis patients: recommendations for a change in management. Am J Kidney 35:1226–1237CrossRefGoogle Scholar
  5. 5.
    Guideline Working Group, Japanese Society for Dialysis therapy (2008) Clinical practice guideline for the management of secondary hyperparathyroidism in chronic dialysis patients. Ther Apher Dial 6:514–525CrossRefGoogle Scholar
  6. 6.
    Fukagawa M, Yokoyama K, Koiwa F et al (2013) Clinical practice guideline for the management of chronic kidney disease-mineral and bone disorder. Ther Apher Dial 17:247–288CrossRefPubMedGoogle Scholar
  7. 7.
    Cunningham J, Locatelli F, Rodriguez M (2011) Secondary hyperparathyroidism: pathogenesis, disease progression, and therapeutic options. Clin J Am Soc Nephrol 6:913–921CrossRefPubMedGoogle Scholar
  8. 8.
    Torres VE, Harris PC, Pirson Y (2007) Autosomal dominant polycystic kidney disease. Lancet 369:1287–1301CrossRefPubMedGoogle Scholar
  9. 9.
    Wilson L, Felsenfeld A, Drezner MK et al (1985) Altered divalent ion metabolism in early renal failure: role of 1,25(OH)2D. Kidney Int 27:565–573CrossRefPubMedGoogle Scholar
  10. 10.
    Koenig KG, Lindberg JS, Zerwekh JE et al (1992) Free and total 1,25-dihydroxyvitamin D levels in subjects with renal disease. Kidney Int 41:161–165CrossRefPubMedGoogle Scholar
  11. 11.
    Levin A, Bakris GL, Molitch M et al (2007) Prevalence of abnormal serum vitamin D, PTH, calcium, and phosphorus in patients with chronic kidney disease: results of the study to evaluate early kidney disease. Kidney Int 71:31–38CrossRefPubMedGoogle Scholar
  12. 12.
    Gutiérrez OM, Isakova T, Andress DL et al (2008) Prevalence and severity of disordered mineral metabolism in Blacks with chronic kidney disease. Kidney Int 73:956–962CrossRefPubMedGoogle Scholar
  13. 13.
    Gutierrez O, Isakova T, Rhee E et al (2005) Fibroblast growth factor-23 mitigates hyperphosphatemia but accentuates calcitriol deficiency in chronic kidney disease. J Am Soc Nephrol 16:2205–2215CrossRefPubMedGoogle Scholar
  14. 14.
    Saito H, Kusano K, Kinosaki M et al (2003) Human fibroblast growth factor-23 mutants suppress Na+-dependent phosphate co-transport activity and 1alpha,25-dihydroxyvitamin D3 production. J Bio Chem 278:2206–2211CrossRefGoogle Scholar
  15. 15.
    Silver J, Naveh-Many T, Mayer H et al (1986) Regulation by vitamin D metabolites of parathyroid hormone gene transcription in vivo in the rat. J Clin Investig 78:1296–1301CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Hsu CH, Patel SR, Young EW et al (1994) The biological action of calcitriol in renal failure. Kidney Int 46:605–612CrossRefPubMedGoogle Scholar
  17. 17.
    Malluche HH, Mawad H, Koszewski NJ (2002) Update on vitamin D and its newer analogues: actions and rationale for treatment in chronic renal failure. Kidney Int 62:367–374CrossRefPubMedGoogle Scholar
  18. 18.
    Hamdy NA, Kanis JA, Beneton MN et al (1995) Effect of alfacalcidol on natural course of renal bone disease in mild to moderate renal failure. BMJ 310:358–363CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Rix M, Eskildsen P, Olgaard K (2004) Effect of 18 months of treatment with alfacalcidol on bone in patients with mild to moderate chronic renal failure. Nephrol Dial Transplant 19:870–876CrossRefPubMedGoogle Scholar
  20. 20.
    Coyne D, Acharya M, Qiu P et al (2006) Paricalcitol capsule for the treatment of secondary hyperparathyroidism in stages 3 and 4 CKD. Am J Kidney Dis 47:263–276CrossRefPubMedGoogle Scholar
  21. 21.
    Teng M, Wolf M, Lowrie E et al (2003) Survival of patients undergoing hemodialysis with paricalcitol or calcitriol therapy. N Engl J Med 349:446–456CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2017

Authors and Affiliations

  • Manabu Okada
    • 1
    • 2
  • Yoshihiro Tominaga
    • 1
  • Takahisa Hiramitsu
    • 1
  • Toshihiro Ichimori
    • 1
  1. 1.Department of Transplantation and Endocrine SurgeryNagoya Daini Red Cross HospitalNagoyaJapan
  2. 2.Department of Renal Transplant SurgeryAichi Medical University School of MedicineNagakuteJapan

Personalised recommendations