[Indications for parathyroidectomy in renal hyperparathyroidism: comments on the significance of new therapeutics].
New therapeutics for the treatment of chronic kidney disease and secondary hyperparathyroidism, such as calcium and aluminium-free phosphate binders, calcimimetic agents and active vitamin D metabolites may decrease the need for parathyroidectomy. The calcimimetic cinacalcet does not induce a longer lasting regression of renal hyperparathyroidism and autonomous growing of parathyroids and the therapeutic effect is limited to the period of treatment. The classical indications for surgery, hypercalcemia, vascular calcification, severe osteopathy, drug-resistant hyperphosphatemia and calciphylaxis are still valid if patients do not respond to medical therapy under the condition that adynamic bone disease is excluded. Individual operative risk factors and improvement of quality of life are important supplementary factors for the indication for parathyroidectomy.
Dotzenrath
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Helios Klinikum Wuppertal, Klinik für Endokrine Chirurgie, Heusnerstraße 40, 42283, Wuppertal, Deutschland. cornelia.dotzenrath@helios-kliniken.de
D057966:Calcimimetic Agents / Q000627:therapeutic use*; D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000209:etiology / Q000601:surgery; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000188:drug therapy; D016105:Parathyroidectomy / Q000009:adverse effects / Q000379:methods* / Q000639:trends; D011788:Quality of Life
D057966:Calcimimetic Agents