title: Effect of parathyroidectomy and cinacalcet on quality of life in patients with end-stage renal disease-related hyperparathyroidism: a systematic review.
abstract: BACKGROUND
  Patients with end-stage renal disease (ESRD) have a decreased quality of life (QoL), which is attributable in part to ESRD-related hyperparathyroidism (HPT). Both cinacalcet and parathyroidectomy (PTx) are treatments for advanced HPT, but their effects on QoL are unclear. We performed a systematic review to evaluate the impact of cinacalcet and PTx on QoL.
  
  
  METHODS
  A systematic literature search was performed using PubMed and EMBASE databases to identify relevant articles. The search was based on the following keywords: 'parathyroidectomy' or 'cinacalcet', 'secondary hyperparathyroidism' or 'renal hyperparathyroidism' combined with 'quality of life' or 'SF-36' or 'symptomatology'. Only studies reporting on QoL at baseline and during follow-up were included. QoL scores were extracted from the selected manuscripts and weighted means were calculated. Due to a lack of available data on QoL improvement in patients using cinacalcet, a meta-analysis could not be performed.
  
  
  RESULTS
  In all, eight articles reached our inclusion criteria. Of this, five articles reported the effect of PTx on QoL. All PTx studies were observational and non-controlled. The physical component scores of the 36-item Medical Outcomes Study Short-Form Health Survey increased significantly with a weighted mean of 35.5% (P < 0.05). Mental component scores increased with 13.7% (P < 0.05). Parathyroidectomy assessment of symptom scores improved from 561 preoperatively to 302 postoperatively (-259 points; -46.2%). Visual analogue scale scores decreased significantly for skin itching (46.6%), joint pain (30.4%) and muscle weakness (28.7%) (P < 0.05). Three studies on the effect of cinacalcet on QoL were included, including one randomized controlled trial. None of these studies showed significant improvement of physical component and mental component scores.
  
  
  CONCLUSIONS
  PTx improved QoL in patients treated for ESRD-related HPT, whereas cinacalcet did not. The difference in impact between PTx and cinacalcet on QoL has not been compared directly.
authors.affiliation: Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Willemijn Y
authors.initials: WY
authors.lastname: van der Plas
authors.affiliation: Department of Surgery, Erasmus University, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Roderick R
authors.initials: RR
authors.lastname: Dulfer
authors.affiliation: Department of Endocine Surgery, University of Sydney, Royal North Shore Hospital, Sydney, Australia.
authors.forename: Anton F
authors.initials: AF
authors.lastname: Engelsman
authors.affiliation: Department of Internal Medicine and Nephrology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Liffert
authors.initials: L
authors.lastname: Vogt
authors.affiliation: Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Martin H
authors.initials: MH
authors.lastname: de Borst
authors.affiliation: Department of Surgery, Erasmus University, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Tessa M
authors.initials: TM
authors.lastname: van Ginhoven
authors.affiliation: Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Schelto
authors.initials: S
authors.lastname: Kruijff
mesh_terms: D057966:Calcimimetic Agents / Q000627:therapeutic use*; D000069449:Cinacalcet / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000628:therapy*; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D016105:Parathyroidectomy; D011184:Postoperative Period; D011788:Quality of Life
chemical_list: D057966:Calcimimetic Agents; D000069449:Cinacalcet
keywords: cinacalcet; end-stage renal disease; hyperparathyroidism; parathyroidectomy; quality of life