title: Efficacy of percutaneous ethanol injection therapy (PEIT) is related to the number of parathyroid glands in haemodialysis patients with secondary hyperparathyroidism.
abstract: BACKGROUND
  Percutaneous ethanol injection therapy (PEIT) is used for advanced secondary hyperparathyroidism. We investigated the efficacy, remission period and risk of relapse to determine the effect of the number of hyperplastic glands and other factors on the therapeutic effect of PEIT.
  
  
  METHODS
  We studied 321 patients divided into two groups: effective [serum corrected calcium (cCa) level < or =10.5 mg/dl and serum intact parathyroid hormone (iPTH) level < or =250 pg/ml], and ineffective (failed to achieve the target levels). Advanced hyperplasia was defined as an estimated volume > or =0.5 cm(3) on ultrasonography.
  
  
  RESULTS
  PEIT was effective in 201 patients (62.6%), in whom serum iPTH levels dropped from 603+/-292 to 183+/-62 pg/ml (ng/l) and serum cCa levels from 10.7+/-0.8 to 10.1+/-0.5 mg/dl. Univariate analysis identified age, the number of hyperplastic glands and iPTH level as factors related to the efficacy of PEIT. The odds ratio for success vs failure by multivariate analysis was 0.55 times for the number of hyperplastic glands > or =0.5 cm(3) (> or =2 vs 0,1) and 0.29 times for iPTH (> or =500 vs <500 pg/ml). Using the Kaplan-Meier method, the number of hyperplastic glands > or =0.5 cm(3) (> or =2 vs 0,1) was a factor affecting the remission period, with a remission significantly longer seen in the group with one hyperplastic gland (P=0.0025).
  
  
  CONCLUSIONS
  Superior results in efficacy rate, remission period and risk of relapse are obtained when PEIT is restricted to patients with one hyperplastic gland > or =0.5 cm(3).
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama 227-8501, Japan. f-koiwa@showa-university-fujigaoka.gr.jp
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Koiwa
authors.forename: Takatoshi
authors.initials: T
authors.lastname: Kakuta
authors.forename: Reika
authors.initials: R
authors.lastname: Tanaka
authors.forename: Shigeru
authors.initials: S
authors.lastname: Yumita
mesh_terms: D000328:Adult; D000368:Aged; D002118:Calcium / Q000097:blood; D000431:Ethanol / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D006965:Hyperplasia; D007279:Injections, Subcutaneous; D007564:Japan; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010280:Parathyroid Glands / Q000000981:diagnostic imaging / Q000187:drug effects / Q000473:pathology*; D010281:Parathyroid Hormone / Q000097:blood; D012074:Remission Induction; D006435:Renal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D010281:Parathyroid Hormone; D000431:Ethanol; D002118:Calcium