title: Is intraoperative parathyroid hormone testing in patients with renal insufficiency undergoing parathyroidectomy for primary hyperparathyroidism accurate?
abstract: BACKGROUND
  Our aim was to determine whether chronic renal insufficiency (CRI) impacted intraoperative parathyroid hormone (ioPTH) monitoring during parathyroidectomy. We hypothesized that ioPTH monitoring in patients with CRI would show slower decline, but would still accurately predict cure.
  
  
  METHODS
  A retrospective review was conducted of patients with primary hyperparathyroidism who underwent curative single adenoma parathyroidectomy. The percentage of patients reaching 50% decline of ioPTH was compared between groups stratified by renal function.
  
  
  RESULTS
  Between 2000 and 2013, 950 patients met inclusion criteria. At 5 minutes, 66% of patients with CRI met curative criteria versus 77% of normal renal function patients (P = .001). At 10 minutes, 89% vs 92% met criteria (P = .073), and by 15 minutes, the gap narrowed to 95% vs 97% (P = .142), respectively.
  
  
  CONCLUSIONS
  Despite CRI patients with primary hyperparathyroidism having slower ioPTH decline after curative parathyroidectomy, 95% met ioPTH criteria by 15 minutes. Standard ioPTH criteria can be used with CRI patients.
authors.affiliation: Department of Surgery, University of California - San Francisco, San Francisco, CA, USA.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Sohn
authors.affiliation: Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Oltmann
authors.affiliation: Department of Surgery, University of Wisconsin, Madison, WI, USA.
authors.forename: David F
authors.initials: DF
authors.lastname: Schneider
authors.affiliation: Department of Surgery, University of Wisconsin, Madison, WI, USA.
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Sippel
authors.affiliation: Department of Surgery, University of Wisconsin, Madison, WI, USA.
authors.forename: Herbert
authors.initials: H
authors.lastname: Chen
authors.affiliation: Department of Surgery, University of Wisconsin, Madison, WI, USA. Electronic address: elfenbein@surgery.wisc.edu.
authors.forename: Dawn M
authors.initials: DM
authors.lastname: Elfenbein
mesh_terms: D000368:Aged; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000097:blood / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D016343:Monitoring, Intraoperative / Q000379:methods*; D010281:Parathyroid Hormone / Q000097:blood*; D016105:Parathyroidectomy / Q000379:methods*; D051437:Renal Insufficiency / Q000097:blood / Q000150:complications*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D010281:Parathyroid Hormone; D003404:Creatinine
keywords: Chronic renal insufficiency; Intraoperative PTH monitoring; Minimally invasive parathyroidectomy; Primary hyperparathyroidism