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Survival after parathyroidectomy in chronic hemodialysis patients with severe secondary hyperparathyroidism

  • Nephrology - Original article
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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.

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Acknowledgments

This paper was published under the frame of European Social Fund, Human Resources Development Operational Program 2007–2013, Project No. POSDRU/159/1.5/138776.

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Authors and Affiliations

  1. Department of Nephrology, University of Medicine and Pharmacy “Iuliu Hatieganu”, Cluj-Napoca, Romania

    Diana Moldovan, Ina Maria Kacso, Crina Rusu, Alina Potra & Mirela Gherman-Căprioară

  2. Nefromed Dialysis Center, Cluj-Napoca, Romania

    Simona Racasan & Ioan Mihai Patiu

  3. Department of Statistics, University of Medicine and Pharmacy “Iuliu Hatieganu”, Cluj-Napoca, Romania

    Cosmina Bondor

  4. Emergency County Hospital, “Mihai Manasia” Nephrology and Dialysis Clinic, 3-5 Clinicilor Street, Cluj- Napoca, Romania

    Diana Moldovan

Authors
  1. Diana Moldovan
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  2. Simona Racasan
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  3. Ina Maria Kacso
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  4. Crina Rusu
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Correspondence to Diana Moldovan.

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Moldovan, D., Racasan, S., Kacso, I.M. et al. Survival after parathyroidectomy in chronic hemodialysis patients with severe secondary hyperparathyroidism. Int Urol Nephrol 47, 1871–1877 (2015). https://doi.org/10.1007/s11255-015-1106-x

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  • DOI: https://doi.org/10.1007/s11255-015-1106-x

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