[Clinical practice guidelines for severe renal hyperparathyroidism]

Clinical practice guidelines for bone metabolism and disease in chronic kidney disease (CKD) proposed parathyroidectomy (PTX) in patients with CKD. As surgical indications, the guideline recommended that PTX should be performed in patients with severe hyperparathyroidism (persistent serum i-PTH > 800 pg/mL), associated with hypercalcemia and/or hyperphosphatemia that are refractory to medical treatment. However, the indications are not well defined and there are no studies to define absolute biomedical criteria. The clinical studies is needed to define appropriate indications for surgical treatment. It was confirmed that effective surgical therapy of severe secondary hyperparathyroidism can be accomplished by subtotal PTX or total PTX with autograft.