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Type of subtotal parathyroidectomy and evolution of parathyroid hormone levels in end-stage renal disease patients: a retrospective cohort study

  • Nephrology - Original Paper
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Abstract

Purpose

Parathyroidectomy (PTX) is performed in end-stage renal disease (ESRD) for the treatment of secondary hyperparathyroidism. Whether and how the number of glands removed affects parathyroid hormone (PTH) levels remain controversial. The objective of this study is to compare the biochemical and pharmacological evolution after subtotal PTX according to the number of glands removed in ESRD.

Methods

This is a unicenter longitudinal retrospective cohort study of ESRD patients who have undergone PTX [< 3 glands (group 1) vs ≥ 3 glands (group 2)] from April 2006 to October 2014 at CHU de Québec, Canada. Demographic data, comorbidities, pharmacological and biochemical parameters were collected before, 3, 6, 12 and 24 months after PTX. Linear mixed model was performed to compare the biochemical and pharmacological evolution.

Results

We included 37 (13 in group 1, 24 in group 2) ESRD patients with a median age of 53 (46–58) years. The population is 68% male with a median dialysis vintage of 30.7 (18.0–61.2) months. The two groups were similar in terms of demographics and comorbidities. Compared to baseline, PTH levels in groups 1 and 2 dropped significantly at 2 years (1239–361 ng/L and 1542–398 ng/L, p < 0.05) but the evolution was comparable between the two groups.

Conclusions

Our results show the efficacy of subtotal PTX in lowering PTH levels in our ESRD cohort. However, the results were not different according to the number of glands removed.

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References

  1. Arora P, Vasa P, Brenner D, Iglar K, McFarlane P, Morrison H, Badawi A (2013) Prevalence estimates of chronic kidney disease in Canada: results of a nationally representative survey. CMAJ 185:E417–423

    Article  Google Scholar 

  2. Naylor KL, McArthur E, Leslie WD et al (2014) The three-year incidence of fracture in chronic kidney disease. Kidney Int 86:810–818

    Article  Google Scholar 

  3. Jean G, Terrat JC, Vanel T, Hurot JM, Lorriaux C, Mayor B, Chazot C (2010) Calciphylaxis in dialysis patients: to recognize and treat it as soon as possible. Nephrol Ther 6:499–504

    Article  Google Scholar 

  4. Rejnmark L, Vestergaard P, Mosekilde L (2011) Nephrolithiasis and renal calcifications in primary hyperparathyroidism. J Clin Endocrinol Metab 96:2377–2385

    Article  CAS  Google Scholar 

  5. Mac Way F, Lessard M, Lafage-Proust MH (2012) Pathophysiology of chronic kidney disease-mineral and bone disorder. Jt Bone Spine 79:544–549

    Article  CAS  Google Scholar 

  6. Goodman WG, London G, Amann K et al (2004) Vascular calcification in chronic kidney disease. Am J Kidney Dis 43:572–579

    Article  Google Scholar 

  7. Bortotolotto LA, Costa-Hong V, Jorgetti V, Consolim-Colombo F, Rosa K, Silva BC, Krieger EM, De Lima JJ (2007) Vascular changes in chronic renal disease patients with secondary hyperparathyroidism. J Nephrol 20:66–72

    PubMed  Google Scholar 

  8. Slinin Y, Foley RN, Collins AJ (2005) Calcium, phosphorus, parathyroid hormone, and cardiovascular disease in hemodialysis patients: the USRDS waves 1, 3, and 4 study. J Am Soc Nephrol 16:1788–1793

    Article  CAS  Google Scholar 

  9. Tentori F, Blayney MJ, Albert JM et al (2008) Mortality risk for dialysis patients with different levels of serum calcium, phosphorus, and PTH: the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis 52:519–530

    Article  CAS  Google Scholar 

  10. (2017) KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorders (CKD-MBD). Kidney Int Suppl 7:1–59

  11. Madorin C, Owen RP, Fraser WD et al (2012) The surgical management of renal hyperparathyroidism. Eur Arch Otorhinolaryngol 269:1565–1576

    Article  Google Scholar 

  12. Ma TL, Hung PH, Jong IC, Hiao CY, Hsu YH, Chiang PC, Guo HR, Hung KY (2015) Parathyroidectomy is associated with reduced mortality in hemodialysis patients with secondary hyperparathyroidism. Biomed Res Int 2015:639587

    PubMed  PubMed Central  Google Scholar 

  13. Chen L, Wang K, Yu S, Lai L, Zhang X, Yuan J, Duan W (2016) Long-term mortality after parathyroidectomy among chronic kidney disease patients with secondary hyperparathyroidism: a systematic review and meta-analysis. Ren Fail 38:1050–1058

    Article  CAS  Google Scholar 

  14. Pihlstrøm H, Dahle DO, Mjøen G, Pilz S, März W, Abedini S, Holme I, Fellström B, Jardine AG, Holdaas H (2015) Increased risk of all-cause mortality and renal graft loss in stable renal transplant recipients with hyperparathyroidism. Transplantation 99:351–359

    Article  Google Scholar 

  15. Messa P, Cafforio C, Alfieri C (2011) Clinical impact of hypercalcemia in kidney transplant. Int J Nephrol 2011:906832

    Article  Google Scholar 

  16. Neagoe RM, Muresan M, Voidazan S, Pascanu I, Radu CP, Sala DT (2016) Subtotal parathyroidectomy versus total parathyroidectomy with autotransplant in secondary hyperparathyroidism—a single-centre prospective cohort of 43 patients. Endokrynol Pol 67:202–209

    Article  Google Scholar 

  17. Gagne ER, Urena P, Leite-Silva S, Zingraff J, Chevalier A, Sarfati E, Dubost C, Drueke TB (1992) Short- and long-term efficacy of total parathyroidectomy with immediate autografting compared with subtotal parathyroidectomy in hemodialysis patients. J Am Soc Nephrol 3:1008–1017

    CAS  PubMed  Google Scholar 

  18. Chen J, Zhou QY, Wang JD (2015) Comparison between subtotal parathyroidectomy and total parathyroidectomy with autotransplantation for secondary hyperparathyroidism in patients with chronic renal failure: a meta-analysis. Horm Metab Res 47:643–651

    Article  CAS  Google Scholar 

  19. Group KDIGOKC-MUW (2017) KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorders (CKD-MBD). Kidney Int Suppl 7:1–59

    Article  Google Scholar 

  20. Lau WL, Obi Y, Kalantar-Zadeh K (2018) Parathyroidectomy in the management of secondary hyperparathyroidism. Clin J Am Soc Nephrol 13:952–961

    PubMed  PubMed Central  Google Scholar 

  21. Drakopoulos S, Koukoulaki M, Apostolou T, Pistolas D, Balaska K, Gavriil S, Hadjiconstantinou V (2009) Total parathyroidectomy without autotransplantation in dialysis patients and renal transplant recipients, long-term follow-up evaluation. Am J Surg 198:178–183

    Article  Google Scholar 

  22. Konturek A, Barczynski M, Stopa M, Nowak W (2016) Subtotal parathyroidectomy for secondary renal hyperparathyroidism: a 20-year surgical outcome study. Langenbecks Arch Surg 401:965–974

    Article  Google Scholar 

  23. Sharma J, Raggi P, Kutner N, Bailey J, Zhang R, Huang Y, Herzog CA, Weber C (2012) Improved long-term survival of dialysis patients after near-total parathyroidectomy. J Am Coll Surg 214:400–407 (discussion 407–408)

    Article  Google Scholar 

  24. Schneider R, Slater EP, Karakas E, Bartsch DK, Schlosser K (2012) Initial parathyroid surgery in 606 patients with renal hyperparathyroidism. World J Surg 36:318–326

    Article  Google Scholar 

  25. Wetmore JB, Liu J, Do TP, Lowe KA, Ishani A, Bradbury BD, Block GA, Collins AJ (2016) Changes in secondary hyperparathyroidism-related biochemical parameters and medication use following parathyroidectomy. Nephrol Dial Transplant 31:103–111

    Article  CAS  Google Scholar 

  26. Mazzaferro S, Pasquali M, Farcomeni A, Vestri AR, Filippini A, Romani AM, Barresi G, Pugliese F (2008) Parathyroidectomy as a therapeutic tool for targeting the recommended NKF-K/DOQI ranges for serum calcium, phosphate and parathyroid hormone in dialysis patients. Nephrol Dial Transplant 23:2319–2323

    Article  CAS  Google Scholar 

  27. Nichols P, Owen JP, Ellis HA, Farndon JR, Kelly PJ, Ward MK (1990) Parathyroidectomy in chronic renal failure: a nine-year follow-up study. Q J Med 77:1175–1193

    Article  CAS  Google Scholar 

  28. Albuquerque RFC, Carbonara CEM, Martin RCT, Dos Reis LM, do Nascimento CPJ, Arap SS, Moyses RMA, Jorgetti V, Montenegro FLM, de Oliveira RB (2018) Parathyroidectomy in patients with chronic kidney disease: impacts of different techniques on the biochemical and clinical evolution of secondary hyperparathyroidism. Surgery 163:381–387

    Article  Google Scholar 

  29. Tang JA, Salapatas AM, Bonzelaar LB, Friedman M (2017) Parathyroidectomy for the treatment of hyperparathyroidism: thirty-day morbidity and mortality. Laryngoscope

  30. Dulfer RR, Franssen GJH, Hesselink DA, Hoorn EJ, van Eijck CHJ, van Ginhoven TM (2017) Systematic review of surgical and medical treatment for tertiary hyperparathyroidism. Br J Surg 104:804–813

    Article  CAS  Google Scholar 

  31. Anderson K Jr, Ruel E, Adam MA, Thomas S, Youngwirth L, Stang MT, Scheri RP, Roman SA, Sosa JA (2017) Subtotal vs. total parathyroidectomy with autotransplantation for patients with renal hyperparathyroidism have similar outcomes. Am J Surg 214:914–919

    Article  Google Scholar 

  32. Iwamoto N, Sato N, Nishida M et al (2016) Low parathyroid hormone levels after parathyroidectomy reduce cardiovascular mortality in chronic hemodialysis patients. Clin Exp Nephrol 20:808–814

    Article  CAS  Google Scholar 

  33. Ishani A, Liu J, Wetmore JB, Lowe KA, Do T, Bradbury BD, Block GA, Collins AJ (2015) Clinical outcomes after parathyroidectomy in a nationwide cohort of patients on hemodialysis. Clin J Am Soc Nephrol 10:90–97

    Article  CAS  Google Scholar 

  34. Kuo LE, Wachtel H, Karakousis G, Fraker D, Kelz R (2014) Parathyroidectomy in dialysis patients. J Surg Res 190:554–558

    Article  Google Scholar 

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Acknowledgements

Special thanks to the dialysis team of CHU de Québec, Hôtel-Dieu de Québec Hospital.

Funding

YPW holds a master scholarship from Canadian Institutes of Health Research (CIHR), Fondation du CHU de Québec and from Université Laval’s leadership and sustainable development program; AS holds a doctorate scholarship from Société Québécoise d’Hypertension Artérielle and CIHR; LCD holds a master scholarship from CIHR, Fonds de Recherche du Québec Santé (FRQS) and the Medicine Faculty of Laval University. Dr Mac-Way holds a scholarship from FRQS and was a past awardee of the KRESCENT program from CIHR, Canadian Society of Nephrology and the Kidney Foundation of Canada. He is also supported by the Department of Medicine and the Fondation du CHU de Québec from Université Laval. Funding organisms did not have any role in the design of the study and collection, analysis, and interpretation of data and in writing manuscript.

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Authors and Affiliations

  1. CHU de Québec Research Center, L’Hôtel-Dieu de Québec Hospital, Endocrinology and Nephrology Axis, Faculty and Department of Medicine, Université Laval, 10 McMahon, Quebec, QC, G1R 2J6, Canada

    Yue-Pei Wang, Aboubacar Sidibé, Louis-Octave Roussy, Louis-Charles Desbiens & Fabrice Mac-Way

  2. CHU de Québec, L’Hôtel-Dieu de Québec Hospital, Faculty of Medicine, Department of Surgery, Université Laval, Quebec, QC, Canada

    Alain Gilbert

Authors
  1. Yue-Pei Wang
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  2. Aboubacar Sidibé
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  3. Louis-Octave Roussy
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  4. Louis-Charles Desbiens
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  6. Fabrice Mac-Way
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Contributions

Y-PW has collected and interpreted patients data and has drafted the final manuscript. AS has analyzed and interpreted patients data and has revised the manuscript. L-OR has collected patients data and revised the manuscript. L-CD has interpreted patients data and revised the manuscript. AG performed all PTX, collected patients data and revised the manuscript. FM-W has elaborated the design of the study, interpreted patents data and revised the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Fabrice Mac-Way.

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Conflict of interest

The authors declare that they have no competing interests.

Ethics approval and consent to participate

All procedures performed in studies involving human participants were in accordance with the ethical standards of the CHU de Québec of Université Laval (IRB approval number 2016-2551) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Availability of data and material

The datasets used and analysed during the current study are available from the corresponding author on reasonable request.

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Wang, YP., Sidibé, A., Roussy, LO. et al. Type of subtotal parathyroidectomy and evolution of parathyroid hormone levels in end-stage renal disease patients: a retrospective cohort study. Int Urol Nephrol 52, 2171–2178 (2020). https://doi.org/10.1007/s11255-020-02574-z

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  • DOI: https://doi.org/10.1007/s11255-020-02574-z

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