title: Surgical management of secondary hyperparathyroidism in chronic kidney disease--a consensus report of the European Society of Endocrine Surgeons.
abstract: BACKGROUND
  Despite advances in the medical management of secondary hyperparathyroidism due to chronic renal failure and dialysis (renal hyperparathyroidism), parathyroid surgery remains an important treatment option in the spectrum of the disease. Patients with severe and complicated renal hyperparathyroidism (HPT), refractory or intolerant to medical therapy and patients with specific requirements in prospect of or excluded from renal transplantation may require parathyroidectomy for renal hyperparathyroidism.
  
  
  METHODS
  Present standard and actual controversial issues regarding surgical treatment of patients with hyperparathyroidism due to chronic renal failure were identified, and pertinent literature was searched and reviewed. Whenever applicable, evaluation of the level of evidence concerning diagnosis and management of renal hyperparathyroidism according to standard criteria and recommendation grading were employed. Results were discussed at the 6th Workshop of the European Society of Endocrine Surgeons entitled Hyperparathyroidism due to multiple gland disease: An evidence-based perspective.
  
  
  RESULTS
  Presently, literature reveals scant data, especially, no prospective randomized studies to provide sufficient levels of evidence to substantiate recommendations for surgery in renal hyperparathyroidism. Appropriate surgical management of renal hyperparathyroidism involves standard bilateral exploration with bilateral cervical thymectomy and a spectrum of four standardized types of parathyroid resection that reveal comparable outcome results with regard to levels of evidence and recommendation. Specific patient requirements may favour one over the other procedure according to individualized demands.
  
  
  CONCLUSIONS
  Surgery for patients with renal hyperparathyroidism in the era of calcimimetics continues to play an important role in selected patients and achieves efficient control of hyperparathyroidism. The overall success rate and long-term control of renal hyperparathyroidism and optimal handling of postoperative metabolic effects also depend on the timely indication, individually suitable type of parathyroid resection and specialized endocrine surgery.
authors.affiliation: Department of General-, Visceral-, and Vascular Surgery, Martin-Luther University of Halle-Wittenberg, Ernst-Grube-Str. 40, Halle (Saale), 06120, Germany. kerstin.lorenz@uk-halle.de.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Lorenz
authors.affiliation: Department of Visceral, Thoracic and Vascular Surgery, Philipps University Marburg, Baldingerstraße 1, Marburg, 35043, Germany. bartsch@med.uni-marburg.de.
authors.forename: Detlef K
authors.initials: DK
authors.lastname: Bartsch
authors.affiliation: Department of General Surgery, Endocrine Surgery Unit, Hospital del Mar, Universitat Autònoma de Barcelona, Passeig Marítim 25-29, Barcelona, 08003, Spain. JSancho@parcdesalutmar.cat.
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Sancho
authors.affiliation: Department of Thoracic and Endocrine Surgery, University Hospitals of Geneva, Switzerland, Rue Gabrielle Perret-Gentil 4, 14, Geneva, 1211, Switzerland. Sebastien.Guigard@hcuge.ch.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Guigard
authors.affiliation: Chirurgie thoracique et endocrinienne, Hôpitaux Universitaires de Genève, Rue Gabrielle Perret-Gentil 4, 14, Geneva, 1211, Switzerland. frederic.triponez@hcuge.ch.
authors.forename: Frederic
authors.initials: F
authors.lastname: Triponez
mesh_terms: D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000209:etiology* / Q000601:surgery*; D007676:Kidney Failure, Chronic / Q000150:complications*; D016105:Parathyroidectomy; D006435:Renal Dialysis
keywords: Cinacalcet; IOPTH; Parathyroidectomy; Renal hyperparathyroidism; Tertiary hyperparathyroidism; Thymectomy