title: Secondary hyperparathyroidism status in Brazil: Brazilian census of parathyroidectomy.
abstract: BACKGROUND
  Secondary hyperparathyroidism (SHP) is a common and serious complication of chronic kidney disease (CKD), with a negative impact on morbidity and mortality. Despite advances in the clinical management of SHP, treatment failure still occurs in a significant number of patients. In such cases, parathyroidectomy (PTx) is indicated.
  
  
  OBJECTIVE
  To have an overview of the prevalence of severe SHP and of its surgical treatment in hemodialysis (HD) patients in Brazil.
  
  
  METHODS
  This was an observational and descriptive study. Data were obtained from questionnaires posted to 660 dialysis units (DU).
  
  
  RESULTS
  Results are expressed in absolute values and percentages, or means and standard deviation, as appropriate. 226 (34%) DU answered the questionnaire, providing data about 32,264 HD patients. The prevalence rate of severe SHP (PTH > 1,000 pg/mL) was 10.7 % (n = 3,463). 68 hospitals countrywide perform PTX. Around 40% of them are university centers. 49 (21.7%) DU reported not to have a specialized medical center to refer their patients with severe SHP. 74 (33%) DU reported that the time interval between surgery indication and its performance was over 6 months. The main recognized obstacles to surgery performance were: difficulty to perform the preoperative exams, lack of head and neck surgeons and the long waiting time.
  
  
  CONCLUSIONS
  Although severe SHP is highly prevalent in Brazil, a significant number of patients do not have access to PTx. Better public health policies and liaison between nephrologists and head and neck surgeons are urgently required to change this reality.
authors.affiliation: Comitê de Distúrbio Mineral e Ósseo na Doença Renal Crônica, Sociedade Brasileira de Nefrologia, São Paulo, SP, Brasil. rodrigobueno.hc@gmail.com
authors.forename: Rodrigo Bueno de
authors.initials: RB
authors.lastname: Oliveira
authors.forename: Eduardo Neves da
authors.initials: EN
authors.lastname: Silva
authors.forename: Douglas Moraes Freire
authors.initials: DM
authors.lastname: Charpinel
authors.forename: José Edevanilson Barros
authors.initials: JE
authors.lastname: Gueiros
authors.forename: Carolina Lara
authors.initials: CL
authors.lastname: Neves
authors.forename: Elisa de Albuquerque
authors.initials: Ede A
authors.lastname: Sampaio
authors.forename: Fellype de Carvalho
authors.initials: Fde C
authors.lastname: Barreto
authors.forename: Cristina
authors.initials: C
authors.lastname: Karohl
authors.forename: Melani Custódio
authors.initials: MC
authors.lastname: Ribeiro
authors.forename: Rosa Maria Affonso
authors.initials: RM
authors.lastname: Moysés
authors.forename: Vanda
authors.initials: V
authors.lastname: Jorgetti
authors.forename: Aluizio Barbosa de
authors.initials: AB
authors.lastname: Carvalho
mesh_terms: D001938:Brazil; D003430:Cross-Sectional Studies; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000453:epidemiology / Q000601:surgery*; D016105:Parathyroidectomy / Q000706:statistics & numerical data*; D015995:Prevalence; D006435:Renal Dialysis; D012720:Severity of Illness Index