Parathyroidectomy as a therapeutic tool for targeting the recommended NKF-K/DOQI ranges for serum calcium, phosphate and parathyroid hormone in dialysis patients.
BACKGROUND
The recommended NKF-K/DOQI'99 ranges for Ca, P and PTH in dialysis seem advisable also for patients previously submitted to parathyroidectomy; however no paper addresses, specifically in this condition, to what extent optimal values are targeted in the short and long term after surgery.


METHODS
We checked serum Ca, P and PTH basally and after 1 month and 1, 3 and 5 years since surgery, in 77 dialysis subjects who received parathyroidectomy in our hospital.


RESULTS
Immediately after surgery all biochemical para- meters dropped, but afterwards Ca showed a tendency to increase progressively in the long term (p <.0006), P increased mostly within one year (p <.01), and PTH increased similarly to Ca (p <.003), but with mean values always in the lower than desired range. The estimated percentage of patients at target during the follow-up was maximal for P (values between 65 and 76%), lower for Ca (zenith of 43% after 1 month but declining down to 14% after 5 years) and minimal for PTH (invariably <10%). Persistence within the ranges (at least on two consecutive checks) was 21% after one month for Ca, with a tendency to reduction; 41% for P, with a tendency to average roughly 30%, and practically zero for PTH. Neither type of surgery (total or subtotal) nor vitamin D therapy were associated with the low values of PTH observed.


CONCLUSIONS
We conclude that parathyroid surgery does not represent an optimal therapeutic tool for targeting the recommended ranges for Ca, P and PTH. In particular, too low PTH values are frequently obtained, whose clinical effects deserve further studies. The possibility of a time dependent risk for recurrence is confirmed.
Mazzaferro
Sandro
S
Department of Clinical Science, Sapienza University of Rome, Italy. sandro.mazzaferro@uniroma1.it
Pasquali
Marzia
M
Farcomeni
Alessio
A
Vestri
Anna Rita
AR
Filippini
Angelo
A
Romani
Anna Maria
AM
Barresi
Giusi
G
Pugliese
Francesco
F
D000328:Adult; D000368:Aged; D002118:Calcium / Q000097:blood*; D005260:Female; D019983:Guideline Adherence; D017408:Guidelines as Topic; D006801:Humans; D006934:Hypercalcemia / Q000097:blood / Q000517:prevention & control; D006962:Hyperparathyroidism, Secondary / Q000097:blood / Q000517:prevention & control; D054559:Hyperphosphatemia / Q000097:blood / Q000517:prevention & control; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood*; D016105:Parathyroidectomy; D010710:Phosphates / Q000097:blood*; D006435:Renal Dialysis; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D010281:Parathyroid Hormone; D010710:Phosphates; D002118:Calcium