[Parathyroidectomy for patients with renal osteodystrophy]

It has been proposed that we should focus our attention on prevention of cardiovascular complication rather than to prevent osteitis fibrosa as the purpose to control secondary hyperparathyroidism (2HPT) induced by chronic renal failure. Active vitamin D and these analogues influence the bone turnover in hemodialysis patients and recently we often encounter the patients whose bone turnover is not high in spite of high PTH level. The aim of parathyroidectomy is gradually changed from improvement of bone disease to reduce high PTH level to prevent cardiovascular complication and extraskeletal symptoms. When it is difficult to control high PTH level without increase of calcium phosphate product, parathyroidectomy should be chosen.