Clinical experience with percutaneous ethanol injection therapy in hemodialysis patients with renal hyperparathyroidism.
BACKGROUND
Percutaneous ethanol injection therapy (PEIT) is a noteworthy method to treat patients with renal hyperparathyroidism (RHPT). This study was performed to enable the authors to propose appropriate indications for PEIT.


METHODS
The authors injected anhydrous ethanol under ultrasonographic guidance into the parathyroid glands of 74 patients with RHPT. The size, volume, and blood vessel density of all parathyroid glands detected were evaluated.


RESULTS
The patients' mean age and hemodialysis duration were 53.8 and 14.3 years, respectively. Intact parathyroid hormone (PTH) levels decreased significantly after treatment (from 950.5 +/- 448.1 to 532.0 +/- 393.2 pg/mL [ng/L], P < 0.05), and the serum calcium and phosphorus levels as well as all bone metabolic parameters had improved. The percentage reduction was greater in cases with 1 gland over 10 mm in maximal diameter, and, as the number of glands over 10 mm rose, the percentage reduction declined. Group A was defined as patients with a small number of glands (1 or 2) with high-grade blood vessel density, and group B as patients with a larger number of such glands. The percentage reduction in intact PTH levels was significantly greater in group A than in group B (56.5 +/- 27.5% v 28.1 +/- 22.0%; P < 0.01).


CONCLUSIONS
the authors' analysis showed that the effectiveness of PEIT was influenced by both the number of glands detected that were more than 10 mm in maximal diameter and by the grade of blood vessel density. They identified appropriate indications for PEIT based on the predictive factors that influenced the efficacy of PEIT.
Nakamura
Michio
M
Department of Surgery, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan. mnaka@kc.twmu.ac.jp
Fuchinoue
Shohei
S
Teraoka
Satoshi
S
D000328:Adult; D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood; D002118:Calcium / Q000097:blood; D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000150:complications; D004351:Drug Resistance; D000431:Ethanol / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015675:Osteocalcin / Q000097:blood; D010280:Parathyroid Glands / Q000473:pathology; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy; D010758:Phosphorus / Q000097:blood; D006435:Renal Dialysis; D014511:Uremia / Q000150:complications* / Q000628:therapy
D010281:Parathyroid Hormone; D015675:Osteocalcin; D010758:Phosphorus; D000431:Ethanol; D000469:Alkaline Phosphatase; D002118:Calcium