title: Parathyroidectomy for the attainment of NKF-K/DOQI™ and KDIGO recommended values for bone and mineral metabolism in dialysis patients with uncontrollable secondary hyperparathyroidism.
abstract: OBJECTIVE
  The National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF-K/DOQI™) 2003 and Kidney Disease: Improving Global Outcomes (KDIGO) 2009 have established guidelines for the treatement of secondary hyperparathyroidism. This study evaluated the impact of parathyroidectomy to achieve recommended values for parathyroid hormone, calcium, phosphorus and CaxPO(4) product in dialysis patients with severe secondary hyperparathyroidism that is resistant to medical treatment.
  
  
  METHODS
  This study included 43 consecutive patients who underwent parathyroidectomy for a severe form of secondary hyperparathyroidism (SHPT) that is unresponsive to medical treatment. The serum iPTH, calcium and phosphorus levels were measured prior to surgery, every morning after surgery for 5 days and on the first, sixth and eighth postoperative months.
  
  
  RESULTS
  Following parathyroidectomy, a significant decline in iPTH values was observed in all patients; however, after the 8-month study period, only one of these patients achieved a serum iPTH concentration within the K/DOQI recommended target range. Unlike iPTH, targeting for calcium, phosphorus and CaxPO(4) at the last follow-up were 55.8%, 60.5% and 93%, respectively. These values indicated a significant improvement in comparison to preoperative percentages. In regards to the KDIGO recommended guidelines, the iPTH levels did not significantly change at the end of our study compared to preoperative values; however, calcium levels significantly declined and phosphorus levels significantly improved compared to preoperative values.
  
  
  CONCLUSIONS
  Although the majority of patients fail to reach recommended iPTH values, parathyroidectomy remains a valuable tool to attain these NKF-K/DOQI recommendations for serum calcium, phosphorus and CaxPO(4) in dialysis patients with secondary hyperparathyroidism resistant to medical therapy. Parathyroidectomy was shown to be an inadequate intervention for achieving KDIGO recommendations.
authors.affiliation: KBC Zvezdara University Clinical Centre, Clinic for Surgery "Nikola Spasic", D. Tucovica 161, 11000 Belgrade, Serbia. bkzvez@gmail.com
authors.forename: Bojan
authors.initials: B
authors.lastname: Kovacevic
authors.forename: Mile
authors.initials: M
authors.lastname: Ignjatovic
authors.forename: Vladan
authors.initials: V
authors.lastname: Zivaljevic
authors.forename: Vladimir
authors.initials: V
authors.lastname: Cuk
authors.forename: Milena
authors.initials: M
authors.lastname: Scepanovic
authors.forename: Zaklina
authors.initials: Z
authors.lastname: Petrovic
authors.forename: Ivan
authors.initials: I
authors.lastname: Paunovic
mesh_terms: D001842:Bone and Bones / Q000378:metabolism*; D002118:Calcium / Q000097:blood; D015897:Comorbidity; D019983:Guideline Adherence; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000453:epidemiology* / Q000378:metabolism / Q000601:surgery*; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000628:therapy; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy; D010758:Phosphorus / Q000097:blood; D017410:Practice Guidelines as Topic; D006435:Renal Dialysis
chemical_list: D010281:Parathyroid Hormone; D010758:Phosphorus; D002118:Calcium