Surgical indications and procedures of parathyroidectomy in patients with chronic kidney disease.
The Kidney Foundation of the USA proposed clinical practice guidelines for bone metabolism and disease in chronic kidney disease including parathyroidectomy (PTx). We performed PTx in a total of 1725 patients with advanced secondary hyperparathyroidism (2HPT) and evaluated the K/DOQI guideline concerning PTx, comparing it with our surgical strategy. The guidelines emphasize the avoidance of ectopic calcification and cardiovascular complications which may be induced by hypercalcemia, hyperphosphatemia, and persistent high parathyroid hormone level. We agree with the attitude of the K/DOQI guideline. To decide surgical indications, we emphasize that the size of parathyroid gland is one of the important factors. The guideline recommends subtotal PTx and total PTx with autotransplantation. We prefer total PTx with forearm autograft, mainly because it is easier and safer to remove the residual parathyroid tissue from the forearm at recurrence compared to neck re-exploration. In Japan, almost all patients require long-term hemodialysis after PTx because of the very small opportunity of kidney transplantation. The risk of recurrence is not negligible. Based on our huge experience we believe our strategy for advanced secondary hyperparathyroidism can be accepted at least in Japan.
Tominaga
Yoshihiro
Y
Department of Surgery, Renal Center, Nagoya Second Red Cross Hospital, 2-9 Myoken-cho Showa-ku Nagoya, Japan 4668650. ytomi@nagoya2.jrc.or.jp
Matsuoka
Susumu
S
Sato
Tetsuhiko
T
D002118:Calcium / Q000097:blood / Q000627:therapeutic use; D005542:Forearm; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D007564:Japan; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D010280:Parathyroid Glands / Q000000981:diagnostic imaging / Q000637:transplantation; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy; D017410:Practice Guidelines as Topic; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D006435:Renal Dialysis; D017256:Technetium Tc 99m Sestamibi; D014182:Transplantation, Autologous; D014481:United States
D010281:Parathyroid Hormone; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi; D002118:Calcium