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For: Wang R, Disharoon M, Frazier R, Xie R, Moses C, Gillis A, Fazendin J, Lindeman B, Gutierrez OM, Chen H. Less Is More: Parathyroidectomy and Association with Postoperative Hypocalcemia in Dialysis Patients. J Am Coll Surg 2023;236:639-645. [PMID: 36728468 DOI: 10.1097/xcs.0000000000000539] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]

For:	Wang R, Disharoon M, Frazier R, Xie R, Moses C, Gillis A, Fazendin J, Lindeman B, Gutierrez OM, Chen H. Less Is More: Parathyroidectomy and Association with Postoperative Hypocalcemia in Dialysis Patients. J Am Coll Surg 2023;236:639-645. [PMID: 36728468 DOI: 10.1097/xcs.0000000000000539] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]

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Cited by Other Article(s)

Yue W, Jiang T, Ai Z, Deng E, Chai H, Li X, He H, Zhang Z, Weng N, Qin X, Fan J, Tang X, Heng W, Li Y, Sun L, Peng C, Xu H. US-guided Percutaneous Radiofrequency Ablation for Secondary Hyperparathyroidism: Long-term Outcomes and Prognostic Factors. Radiology 2024;311:e231852. [PMID: 38625007 DOI: 10.1148/radiol.231852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]

Abstract

Background Although favorable outcomes have been reported with radiofrequency ablation (RFA) for secondary hyperparathyroidism (SHPT), the long-term efficacy remains insufficiently investigated. Purpose To evaluate the long-term efficacy and safety of US-guided percutaneous RFA in patients with SHPT undergoing dialysis and to identify possible predictors associated with treatment failure. Materials and Methods This retrospective study included consecutive patients with SHPT with at least one enlarged parathyroid gland accessible for RFA who were undergoing dialysis at seven tertiary centers from May 2013 to July 2022. The primary end point was the proportion of patients with parathyroid hormone (PTH) levels less than or equal to 585 pg/mL at the end of follow-up. Secondary end points were the proportion of patients with normal calcium and phosphorus levels, the technical success rate, procedure-related complications, and improvement in self-rated hyperparathyroidism-related symptoms (0-3 ranking scale). The Wilcoxon signed rank test and generalized estimating equation model were used to evaluate treatment outcomes. Univariable and multivariable regression analyses identified variables associated with treatment failure (recurrent or persistent hyperparathyroidism). Results This study included 165 patients (median age, 51 years [IQR, 44-60 years]; 92 female) and 582 glands. RFA effectively reduced PTH, calcium, and phosphorus levels, with targeted ranges achieved in 78.2% (129 of 165), 72.7% (120 of 165), and 60.0% (99 of 165) of patients, respectively, at the end of follow-up (mean, 51 months). For the RFA sessions, the technical success rate was 100% (214 of 214). Median symptom scores (ostealgia, arthralgia, pruritus) decreased (all P < .001). Regarding complications, only hypocalcemia (45.8%, 98 of 214) was common. Treatment failure occurred in 36 patients (recurrent [n = 5] or persistent [n = 31] hyperparathyroidism). The only potential independent predictor of treatment failure was having less than four treated glands (odds ratio, 17.18; 95% CI: 4.34, 67.95; P < .001). Conclusion US-guided percutaneous RFA was effective and safe in the long term as a nonsurgical alternative for patients with SHPT undergoing dialysis; the only potential independent predictor of treatment failure was a lower number (<4) of treated glands. © RSNA, 2024 Supplemental material is available for this article.

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Affiliation(s)

Wenwen Yue From the Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, No. 301 Yanchang Zhong Road, Jingan District, Shanghai 200072, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Department of Medical Statistics, School of Medicine, Tongji University, Shanghai, China (Z.A.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (X.L., H.X.); Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China (H.H.); Departments of Ultrasound (Z.Z.) and Nephrology (N.W.), Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China; Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, Hefei, China (X.Q.); Department of Ultrasound, Nanchong Central Hospital, North Sichuan Medical College, Nanchong, China (X.Q.); Department of Ultrasound, Yiwu Fuyuan Hospital, Yiwu, China (J.F., X.T.); and Departments of Ultrasound (W.H.) and Nephrology (Y.L.), The First People's Hospital of Aksu, Xinjiang, China
Tingting Jiang From the Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, No. 301 Yanchang Zhong Road, Jingan District, Shanghai 200072, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Department of Medical Statistics, School of Medicine, Tongji University, Shanghai, China (Z.A.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (X.L., H.X.); Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China (H.H.); Departments of Ultrasound (Z.Z.) and Nephrology (N.W.), Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China; Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, Hefei, China (X.Q.); Department of Ultrasound, Nanchong Central Hospital, North Sichuan Medical College, Nanchong, China (X.Q.); Department of Ultrasound, Yiwu Fuyuan Hospital, Yiwu, China (J.F., X.T.); and Departments of Ultrasound (W.H.) and Nephrology (Y.L.), The First People's Hospital of Aksu, Xinjiang, China
Zisheng Ai From the Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, No. 301 Yanchang Zhong Road, Jingan District, Shanghai 200072, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Department of Medical Statistics, School of Medicine, Tongji University, Shanghai, China (Z.A.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (X.L., H.X.); Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China (H.H.); Departments of Ultrasound (Z.Z.) and Nephrology (N.W.), Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China; Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, Hefei, China (X.Q.); Department of Ultrasound, Nanchong Central Hospital, North Sichuan Medical College, Nanchong, China (X.Q.); Department of Ultrasound, Yiwu Fuyuan Hospital, Yiwu, China (J.F., X.T.); and Departments of Ultrasound (W.H.) and Nephrology (Y.L.), The First People's Hospital of Aksu, Xinjiang, China
Erya Deng From the Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, No. 301 Yanchang Zhong Road, Jingan District, Shanghai 200072, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Department of Medical Statistics, School of Medicine, Tongji University, Shanghai, China (Z.A.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (X.L., H.X.); Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China (H.H.); Departments of Ultrasound (Z.Z.) and Nephrology (N.W.), Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China; Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, Hefei, China (X.Q.); Department of Ultrasound, Nanchong Central Hospital, North Sichuan Medical College, Nanchong, China (X.Q.); Department of Ultrasound, Yiwu Fuyuan Hospital, Yiwu, China (J.F., X.T.); and Departments of Ultrasound (W.H.) and Nephrology (Y.L.), The First People's Hospital of Aksu, Xinjiang, China
Huihui Chai From the Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, No. 301 Yanchang Zhong Road, Jingan District, Shanghai 200072, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Department of Medical Statistics, School of Medicine, Tongji University, Shanghai, China (Z.A.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (X.L., H.X.); Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China (H.H.); Departments of Ultrasound (Z.Z.) and Nephrology (N.W.), Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China; Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, Hefei, China (X.Q.); Department of Ultrasound, Nanchong Central Hospital, North Sichuan Medical College, Nanchong, China (X.Q.); Department of Ultrasound, Yiwu Fuyuan Hospital, Yiwu, China (J.F., X.T.); and Departments of Ultrasound (W.H.) and Nephrology (Y.L.), The First People's Hospital of Aksu, Xinjiang, China
Xiaolong Li From the Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, No. 301 Yanchang Zhong Road, Jingan District, Shanghai 200072, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Department of Medical Statistics, School of Medicine, Tongji University, Shanghai, China (Z.A.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (X.L., H.X.); Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China (H.H.); Departments of Ultrasound (Z.Z.) and Nephrology (N.W.), Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China; Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, Hefei, China (X.Q.); Department of Ultrasound, Nanchong Central Hospital, North Sichuan Medical College, Nanchong, China (X.Q.); Department of Ultrasound, Yiwu Fuyuan Hospital, Yiwu, China (J.F., X.T.); and Departments of Ultrasound (W.H.) and Nephrology (Y.L.), The First People's Hospital of Aksu, Xinjiang, China
Hongfeng He From the Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, No. 301 Yanchang Zhong Road, Jingan District, Shanghai 200072, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Department of Medical Statistics, School of Medicine, Tongji University, Shanghai, China (Z.A.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (X.L., H.X.); Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China (H.H.); Departments of Ultrasound (Z.Z.) and Nephrology (N.W.), Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China; Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, Hefei, China (X.Q.); Department of Ultrasound, Nanchong Central Hospital, North Sichuan Medical College, Nanchong, China (X.Q.); Department of Ultrasound, Yiwu Fuyuan Hospital, Yiwu, China (J.F., X.T.); and Departments of Ultrasound (W.H.) and Nephrology (Y.L.), The First People's Hospital of Aksu, Xinjiang, China
Zhengxian Zhang From the Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, No. 301 Yanchang Zhong Road, Jingan District, Shanghai 200072, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Department of Medical Statistics, School of Medicine, Tongji University, Shanghai, China (Z.A.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (X.L., H.X.); Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China (H.H.); Departments of Ultrasound (Z.Z.) and Nephrology (N.W.), Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China; Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, Hefei, China (X.Q.); Department of Ultrasound, Nanchong Central Hospital, North Sichuan Medical College, Nanchong, China (X.Q.); Department of Ultrasound, Yiwu Fuyuan Hospital, Yiwu, China (J.F., X.T.); and Departments of Ultrasound (W.H.) and Nephrology (Y.L.), The First People's Hospital of Aksu, Xinjiang, China
Ning Weng From the Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, No. 301 Yanchang Zhong Road, Jingan District, Shanghai 200072, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Department of Medical Statistics, School of Medicine, Tongji University, Shanghai, China (Z.A.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (X.L., H.X.); Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China (H.H.); Departments of Ultrasound (Z.Z.) and Nephrology (N.W.), Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China; Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, Hefei, China (X.Q.); Department of Ultrasound, Nanchong Central Hospital, North Sichuan Medical College, Nanchong, China (X.Q.); Department of Ultrasound, Yiwu Fuyuan Hospital, Yiwu, China (J.F., X.T.); and Departments of Ultrasound (W.H.) and Nephrology (Y.L.), The First People's Hospital of Aksu, Xinjiang, China
Xiachuan Qin From the Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, No. 301 Yanchang Zhong Road, Jingan District, Shanghai 200072, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Department of Medical Statistics, School of Medicine, Tongji University, Shanghai, China (Z.A.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (X.L., H.X.); Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China (H.H.); Departments of Ultrasound (Z.Z.) and Nephrology (N.W.), Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China; Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, Hefei, China (X.Q.); Department of Ultrasound, Nanchong Central Hospital, North Sichuan Medical College, Nanchong, China (X.Q.); Department of Ultrasound, Yiwu Fuyuan Hospital, Yiwu, China (J.F., X.T.); and Departments of Ultrasound (W.H.) and Nephrology (Y.L.), The First People's Hospital of Aksu, Xinjiang, China
Jing Fan From the Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, No. 301 Yanchang Zhong Road, Jingan District, Shanghai 200072, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Department of Medical Statistics, School of Medicine, Tongji University, Shanghai, China (Z.A.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (X.L., H.X.); Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China (H.H.); Departments of Ultrasound (Z.Z.) and Nephrology (N.W.), Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China; Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, Hefei, China (X.Q.); Department of Ultrasound, Nanchong Central Hospital, North Sichuan Medical College, Nanchong, China (X.Q.); Department of Ultrasound, Yiwu Fuyuan Hospital, Yiwu, China (J.F., X.T.); and Departments of Ultrasound (W.H.) and Nephrology (Y.L.), The First People's Hospital of Aksu, Xinjiang, China
Xiaoqing Tang From the Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, No. 301 Yanchang Zhong Road, Jingan District, Shanghai 200072, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Department of Medical Statistics, School of Medicine, Tongji University, Shanghai, China (Z.A.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (X.L., H.X.); Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China (H.H.); Departments of Ultrasound (Z.Z.) and Nephrology (N.W.), Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China; Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, Hefei, China (X.Q.); Department of Ultrasound, Nanchong Central Hospital, North Sichuan Medical College, Nanchong, China (X.Q.); Department of Ultrasound, Yiwu Fuyuan Hospital, Yiwu, China (J.F., X.T.); and Departments of Ultrasound (W.H.) and Nephrology (Y.L.), The First People's Hospital of Aksu, Xinjiang, China
Wei Heng From the Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, No. 301 Yanchang Zhong Road, Jingan District, Shanghai 200072, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Department of Medical Statistics, School of Medicine, Tongji University, Shanghai, China (Z.A.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (X.L., H.X.); Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China (H.H.); Departments of Ultrasound (Z.Z.) and Nephrology (N.W.), Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China; Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, Hefei, China (X.Q.); Department of Ultrasound, Nanchong Central Hospital, North Sichuan Medical College, Nanchong, China (X.Q.); Department of Ultrasound, Yiwu Fuyuan Hospital, Yiwu, China (J.F., X.T.); and Departments of Ultrasound (W.H.) and Nephrology (Y.L.), The First People's Hospital of Aksu, Xinjiang, China
Yong Li From the Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, No. 301 Yanchang Zhong Road, Jingan District, Shanghai 200072, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Department of Medical Statistics, School of Medicine, Tongji University, Shanghai, China (Z.A.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (X.L., H.X.); Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China (H.H.); Departments of Ultrasound (Z.Z.) and Nephrology (N.W.), Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China; Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, Hefei, China (X.Q.); Department of Ultrasound, Nanchong Central Hospital, North Sichuan Medical College, Nanchong, China (X.Q.); Department of Ultrasound, Yiwu Fuyuan Hospital, Yiwu, China (J.F., X.T.); and Departments of Ultrasound (W.H.) and Nephrology (Y.L.), The First People's Hospital of Aksu, Xinjiang, China
Liping Sun From the Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, No. 301 Yanchang Zhong Road, Jingan District, Shanghai 200072, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Department of Medical Statistics, School of Medicine, Tongji University, Shanghai, China (Z.A.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (X.L., H.X.); Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China (H.H.); Departments of Ultrasound (Z.Z.) and Nephrology (N.W.), Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China; Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, Hefei, China (X.Q.); Department of Ultrasound, Nanchong Central Hospital, North Sichuan Medical College, Nanchong, China (X.Q.); Department of Ultrasound, Yiwu Fuyuan Hospital, Yiwu, China (J.F., X.T.); and Departments of Ultrasound (W.H.) and Nephrology (Y.L.), The First People's Hospital of Aksu, Xinjiang, China
Chengzhong Peng From the Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, No. 301 Yanchang Zhong Road, Jingan District, Shanghai 200072, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Department of Medical Statistics, School of Medicine, Tongji University, Shanghai, China (Z.A.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (X.L., H.X.); Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China (H.H.); Departments of Ultrasound (Z.Z.) and Nephrology (N.W.), Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China; Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, Hefei, China (X.Q.); Department of Ultrasound, Nanchong Central Hospital, North Sichuan Medical College, Nanchong, China (X.Q.); Department of Ultrasound, Yiwu Fuyuan Hospital, Yiwu, China (J.F., X.T.); and Departments of Ultrasound (W.H.) and Nephrology (Y.L.), The First People's Hospital of Aksu, Xinjiang, China
Huixiong Xu From the Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, No. 301 Yanchang Zhong Road, Jingan District, Shanghai 200072, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Department of Medical Statistics, School of Medicine, Tongji University, Shanghai, China (Z.A.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (X.L., H.X.); Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China (H.H.); Departments of Ultrasound (Z.Z.) and Nephrology (N.W.), Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China; Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, Hefei, China (X.Q.); Department of Ultrasound, Nanchong Central Hospital, North Sichuan Medical College, Nanchong, China (X.Q.); Department of Ultrasound, Yiwu Fuyuan Hospital, Yiwu, China (J.F., X.T.); and Departments of Ultrasound (W.H.) and Nephrology (Y.L.), The First People's Hospital of Aksu, Xinjiang, China

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Wang R, McMullin JL, Allahwasaya A, Akhund R, Fazendin J, Lindeman B, Chen H, Gillis A. Feasibility of an Online Patient-Driven International Parathyroid Registry. J Surg Res 2024;296:217-222. [PMID: 38286100 DOI: 10.1016/j.jss.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/12/2023] [Accepted: 01/02/2024] [Indexed: 01/31/2024]

Abstract

INTRODUCTION

Traditional parathyroid registries are labor-intensive and do not always capture long-term follow-up data. This study aimed to develop a patient-driven international parathyroid registry and leverage community connections to improve patient-centered care for hyperparathyroidism.

METHODS

An anonymous voluntary online survey was developed using Qualtrics and posted in an international patient and advocate-run social media group affiliated with over 11,700 members. The survey was developed from a literature review, expert opinion, and discussion with the social media group managers. It consists of seven sections: patient demographics, past medical history, preoperative symptoms, laboratory evaluation, preoperative imaging studies, operative findings, and operative outcomes.

RESULTS

From July 30, 2022, to October 1, 2022, 89 complete responses were received. Participants were from 12 countries, mostly (82.0%) from the United States across 31 states. Most participants were female (91.4%), White (96.7%) with a mean (±standard deviation) age of 58 ± 12 y. The most common preoperative symptoms were bone or joint pain (84.3%) and neuropsychiatric symptoms: including fatigue (82.0%), brain fog (79.8%), memory loss (79.8%), and difficulty with concentration (75.3%). The median (interquartile range) length from symptom onset to diagnosis was 40.0 (6.8-100.5) mo. Seventy-one percent of participants had elevated preoperative serum calcium, and 73.2% had elevated preoperative parathyroid hormone. All participants obtained preoperative imaging studies (88.4% ultrasound, 86.0% sestabimi scan, and 45.3% computed tomography). Among them, 48.8% of participants received two, and 34.9% had three imaging studies. The median (interquartile range) time from diagnosis to surgical intervention was 3 (2-9) mo. Twenty-two percent of participants traveled to different cities for surgical intervention. Forty-seven percent of participants underwent outpatient parathyroidectomy. Eighty-four percent of participants reported improved symptoms after parathyroidectomy, 12.4% required oral calcium supplementation for more than 6 mo, 32.6% experienced transient hoarseness after parathyroidectomy, and 14.6% required reoperation after initial parathyroidectomy.

CONCLUSIONS

This international online parathyroid registry provides a valuable collection of patient-entered clinical outcomes. The high number of responses over 10 wk demonstrates that participants were willing to be involved in research on their disease. The creation of this registry allows global participation and is feasible for future studies in hyperparathyroidism.

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Wang R, Price G, Disharoon M, Stidham G, McLeod MC, McMullin JL, Gillis A, Fazendin J, Lindeman B, Ong S, Chen H. Resolution of Secondary Hyperparathyroidism After Kidney Transplantation and the Effect on Graft Survival. Ann Surg 2023;278:366-375. [PMID: 37325915 DOI: 10.1097/sla.0000000000005946] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]

Abstract

OBJECTIVE

Hyperparathyroidism (HPT) is nearly universal in patients with end-stage kidney disease. Kidney transplantation (KT) reverses HPT in many patients, but most studies have only focused on following calcium and not parathyroid hormone (PTH) levels. We sought to study the prevalence of persistent HPT post-KT at our center and its effect on graft survival.

METHODS

Patients who underwent KT from January 2015 to August 2021 were included and characterized by post-KT HPT status at the most recent follow-up: resolved (achieving normal PTH post-KT) versus persistent HPT. Those with persistent HPT were further stratified by the occurrence of hypercalcemia (normocalcemic versus hypercalcemic HPT). Patient demographics, donor kidney quality, PTH and calcium levels, and allograft function were compared between groups. Multivariable logistic regression and Cox regression with propensity score matching were conducted.

RESULTS

Of 1554 patients, only 390 (25.1%) patients had resolution of renal HPT post-KT with a mean (±SD) follow-up length of 40±23 months. The median (IQR) length of HPT resolution was 5 (0-16) months. Of the remaining 1164 patients with persistent HPT post-KT, 806 (69.2%) patients had high PTH and normal calcium levels, while 358 (30.8%) patients had high calcium and high PTH levels. Patients with persistent HPT had higher parathyroid hormone (PTH) at the time of KT [403 (243-659) versus 277 (163-454) pg/mL, P <0.001] and were more likely to have received cinacalcet treatment before KT (34.9% vs. 12.3%, P <0.001). Only 6.3% of patients with persistent HPT received parathyroidectomy. Multivariable logistic regression showed race, cinacalcet use pre-KT, dialysis before KT, receiving an organ from a deceased donor, high PTH, and calcium levels at KT were associated with persistent HPT post-KT. After adjusting for patient demographics and donor kidney quality by propensity score matching, persistent HPT (HR 2.5, 95% CI 1.1-5.7, P =0.033) was associated with a higher risk of allograft failure. Sub-analysis showed that both hypercalcemic HPT (HR 2.6, 95% CI 1.1-6.5, P =0.045) and normocalcemic HPT (HR 2.5, 95% CI 1.3-5.5, P =0.021) were associated with increased risk of allograft failure when compared with patients with resolved HPT.

CONCLUSION

Persistent HPT is common (75%) after KT and is associated with a higher risk of allograft failure. PTH levels should be closely monitored after kidney transplantation so that patients with persistent HPT can be treated appropriately.

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