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Parathyroidectomy in dialysis patients.
Angel L M de Francisco1, Gema Fernández Fresnedo, Emilio Rodrigo
1Servicio de Nefrología y Endocrinología, Hospital U Valdecilla, Universidad de Cantabria, Santander, Spain. martinal@unican.es
Kidney International. Supplement
|May 2, 2002
Summary
Total parathyroidectomy (PTx) alone effectively treats severe hyperparathyroidism in patients awaiting renal transplantation. This procedure maintained bone mass and reduced vascular calcification, showing long-term efficacy without autotransplantation.
Area of Science:
- Nephrology
- Endocrinology
- Surgical Pathology
Background:
- Secondary hyperparathyroidism is common in patients with chronic kidney disease awaiting renal transplantation.
- Surgical options include subtotal or total parathyroidectomy (PTx) with autotransplantation.
- Total PTx alone is considered, but recurrence risk due to persistent uremic stimulus is a concern.
Purpose of the Study:
- To evaluate the long-term efficacy of total parathyroidectomy (PTx) alone in uremic patients excluded from renal transplantation.
- To assess bone mineral density and vascular calcification post-total PTx without autotransplantation.
Main Methods:
- Total PTx alone was performed in 15 uremic patients.
- Ten patients with undetectable intact parathyroid hormone (iPTH) levels were followed for 37-144 months.
- Bone mineral density (BMD) and arterial calcification were assessed.
Main Results:
- No clinical bone disease (pain or fractures) was observed.
- BMD z-scores were age-appropriate.
- Low turnover bone disease was confirmed on biopsy.
- Vascular calcification progression was minimal in patients with undetectable iPTH.
Conclusions:
- Total PTx without autotransplantation is a highly effective treatment for refractory severe hyperparathyroidism in patients ineligible for renal transplantation.
- Careful management of dialysis water and phosphate binders is crucial to prevent aluminum-related osteopathy.