title: Long-term outcomes following "presumed" total parathyroidectomy for secondary hyperparathyroidism of chronic kidney disease.
abstract: OBJECTIVE
  The most efficacious surgical treatment for renal hyperparathyroidism is still subject of research. Considering its low incidence rate of long-term relapse, "presumed" total parathyroidectomy without autotrasplantation (TP) may be indicated for secondary hyperparathyroidism (2HPT) in patients with chronic kidney disease (CKD), not eligible for kidney transplantation. The aim of this study was to analyse the TP long-term results in 2HPT haemodialysis (HD) patients.
  
  
  METHODS
  Between January 2004 and October 2009, 25 2HPT HD patients, not eligible for kidney transplantation, underwent TP of at least four parathyroid glands. Clinical status and intact parathyroid hormone (iPTH) serum levels were assessed intraoperatively and during a 36-month follow-up.
  
  
  RESULTS
  TP improved the typical clinical symptoms and a significant reduction of iPTH serum levels was achieved in each patient. Aparathyroidism was never observed; in case of severe postoperative hypocalcemia, hypocalcemic seizures were never reported and the long-term recurrence rate was 8%. Only one patient received a kidney transplantation. Postoperative cardiovascular events (hypertension, peripheral artery disease, arrhythmia, coronary or cerebrovascular disease) were observed in 32% of cases and mortality rate was 16%.
  
  
  CONCLUSIONS
  Considering its low long-term relapse rate and the absence of postoperative aparathyroidism, TP may still be considered the treatment of choice in patients with aggressive forms of 2HPT or of advanced dialytic vintage, with no access to renal transplantation. In case of postoperative hypoparathyroidism, hypocalcaemia can be effectively managed by medical treatment.
authors.affiliation: Second University of Napoli, Napoli, Italia.
authors.forename: G
authors.initials: G
authors.lastname: Conzo
authors.forename: A
authors.initials: A
authors.lastname: Perna
authors.forename: G
authors.initials: G
authors.lastname: Candela
authors.forename: A
authors.initials: A
authors.lastname: Palazzo
authors.forename: D
authors.initials: D
authors.lastname: Parmeggiani
authors.forename: S
authors.initials: S
authors.lastname: Napolitano
authors.forename: Diego
authors.initials: D
authors.lastname: Esposito
authors.forename: Franco
authors.initials: F
authors.lastname: Cavallo
authors.forename: G
authors.initials: G
authors.lastname: Docimo
authors.forename: L
authors.initials: L
authors.lastname: Santini
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood*; D016105:Parathyroidectomy / Q000009:adverse effects / Q000379:methods; D011788:Quality of Life; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D012189:Retrospective Studies; D055502:Secondary Prevention; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D010281:Parathyroid Hormone