Short- and long-term impact of subtotal parathyroidectomy on the achievement of bone and mineral parameters recommended by clinical practice guidelines in dialysis patients: a 12-year single-center experience.
OBJECTIVE
The short- and long-term impact of parathyroidectomy (PTX) on the parameters of mineral bone disease in dialysis patients with severe secondary hyperparathyroidism (HPT) remains unclear.


METHODS
A retrospective chart review of 401 consecutive dialysis patients who underwent subtotal PTX by one surgeon was performed. We checked serum levels of calcium (Ca), phosphorus (P), and intact parathyroid hormone (iPTH) for 3 consecutive days, and then monthly for Ca, P, and tri-monthly for iPTH postoperatively. Patients with available laboratory data within the 1st to 6th postoperative months were included in the short-term follow-up group and those with at least 6 months available data were in the long-term follow-up one.


RESULTS
Patients (short-term group, n = 401, and long-term group, n = 94) had severely uncontrolled serum iPTH levels, Ca, P and Ca × P before PTX. In the short-term group, percentages of cases achieving K/DOQI targets for serum Ca, Ca × P, and iPTH and KDIGO ones for serum Ca, P, and iPTH after PTX, significantly improved compared with those before operation (all p < 0.05). In the long-term group (mean follow-up of 43 ± 29 months), the percentage of achieved targets for serum iPTH in both guidelines and for serum Ca and Ca × P in the K/DOQI recommendation also improved postoperatively (all p < 0.05).


CONCLUSIONS
Achievements of K/DOQI recommended values for serum Ca, Ca × P, iPTH and KDIGO recommendations for iPTH can be successfully reached by subtotal PTX in medically refractory, secondary HPT in dialysis patients both during short- and long-term follow-ups.
Division of Nephrology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC.
Wan-Chuan
WC
Tsai
Yu-Sen
YS
Peng
Ju-Yeh
JY
Yang
Shih-Ping
SP
Hsu
Hon-Yen
HY
Wu
Mei-Fen
MF
Pai
Jia-Feng
JF
Chang
Hung-Yuan
HY
Chen
D000328:Adult; D000368:Aged; D001847:Bone Diseases / Q000097:blood / Q000209:etiology; D001842:Bone and Bones / Q000378:metabolism*; D002118:Calcium / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000209:etiology / Q000601:surgery; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D008903:Minerals / Q000097:blood / Q000378:metabolism*; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy / Q000009:adverse effects*; D010758:Phosphorus / Q000097:blood; D017410:Practice Guidelines as Topic; D006435:Renal Dialysis / Q000009:adverse effects; D012189:Retrospective Studies; D013997:Time Factors
D008903:Minerals; D010281:Parathyroid Hormone; D010758:Phosphorus; D002118:Calcium