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Song Z, Wu C, Wang R, Gillis A, Fazendin J, Lindeman B, Chen H. The Effects of Parathyroidectomy vs Medical Treatments for Secondary Hyperparathyroidism in Patients Undergoing Dialysis: A Meta-Analysis. Endocr Pract 2024; 30:569-576. [PMID: 38583772 DOI: 10.1016/j.eprac.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/27/2024] [Accepted: 04/01/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE The management of secondary hyperparathyroidism in patients undergoing dialysis is debated, with uncontrolled parathyroid hormone (PTH) levels becoming more common despite the expanded use of medical treatments like cinacalcet. This study examines the clinical benefits of parathyroidectomy vs medical treatment in reducing mortality and managing key laboratory parameters in patients undergoing dialysis. METHODS PubMed, Embase, Cochrane, Scopus, and Web of Science databases were searched for cohort studies or randomized controlled trials published before August 18, 2023. We included studies with comparative arms, specifically medical treatment vs surgical intervention. Patients with a history of kidney transplant were excluded. Outcomes were analyzed using hazard ratios (HRs) for mortality and weighted mean differences (WMD) for laboratory parameters. RESULTS Twenty-three studies involving 24 398 patients were analyzed. The pooled meta-analysis has shown a significant reduction in all-cause (HR, 0.47; 95% confidence interval [CI], 0.35-0.61) and cardiovascular mortality (HR, 0.58; 95% CI, 0.40-0.84) for parathyroidectomy vs medical treatments. Subgroup analysis showed that parathyroidectomy was associated with a greater reduction in mortality in patients with a PTH level over 585 pg/mL (HR, 0.37; 95% CI, 0.24-0.58). No mortality difference was found when all patients in the medical group received cinacalcet alongside standard medical treatment (HR, 1.02; 95% CI, 0.49-2.11). Parathyroidectomy also led to a larger decrease in PTH (WMD, 1078 pg/mL; 95% CI, 587-1569), calcium (WMD, 0.86 mg/dL; 95% CI, 0.43-1.28), and phosphate (WMD, 0.74 mg/dL; 95% CI, 0.32-1.16). CONCLUSION Parathyroidectomy may offer a survival advantage compared to medical management in patients with severe secondary hyperparathyroidism.
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Affiliation(s)
- Zhixing Song
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Christopher Wu
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Rongzhi Wang
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Andrea Gillis
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jessica Fazendin
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Brenessa Lindeman
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Herbert Chen
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
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Huang QX, Pang J, Shi CK, Huang XW, Chen XF, Luo YF, An HW, Jian JL, Liu L, Li YL. Impact of parathyroidectomy among nondiabetic hemodialysis patients with severe hyperparathyroidism. Ren Fail 2022; 44:1160-1168. [PMID: 35880645 PMCID: PMC9331203 DOI: 10.1080/0886022x.2022.2098768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background Parathyroidectomy (PTX) is a treatment for hyperparathyroidism (HPT) and has uncertain risks and benefits. The aim of this study was to evaluate the effect of PTX versus nonoperative treatment among nondiabetic hemodialysis patients. Methods A retrospective matched cohort study was performed. Each PTX patient was matched with one patient who had severe HPT but rejected PTX. The patients were matched by sex, birth date, date of first dialysis, nondiabetic status, and left ventricular ejection fraction. The serum markers, survival, main adverse cardiovascular and cerebrovascular event (MACCE) rates, and hospitalization were compared between the PTX patients and matched non-PTX patients. Results There were 1143 patients at our center in the Chinese National Renal Data System (CNRDS) between 2010 and 2020. Of these, 75 PTX patients were matched with 75 non-PTX patients. Rapid decreases in the mean intact parathyroid hormone, calcium and phosphorus concentrations, and a gradual increase in hemoglobin concentration were observed in the PTX group. The mortality was 2.9 per 100 patient-years in the PTX group and 10.9 per 100 patient-years in the non-PTX group (p < 0.001). Compared with non-PTX patients, PTX patients had an adjusted HR for death of 0.236 (95% CI 0.108–0.518). The cumulative MACCE rates were 6.7 per 100 patient-years in the PTX group and 15.2 per 100 patient-years in the non-PTX group (p < 0.001). The adjusted HR of the occurrence of first MACCE for PTX patients compared with non-PTX patients was 0.524 (95% CI 0.279-0.982). The cumulative hospitalization rates were 50.3 per 100 patient-years in the PTX group and 66.5 per 100 patient-years in the matched non-PTX group (p < 0.001). Conclusions Compared with non-PTX patients, PTX was associated with an improvement in the biochemical measures and patient-level outcomes in nondiabetic hemodialysis patients with severe HPT.
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Affiliation(s)
- Qing-Xiu Huang
- Department of Nephrology, Zhongshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Zhongshan, China
| | - Jie Pang
- Department of Nephrology, Zhongshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Zhongshan, China
| | - Chuan-Ke Shi
- Department of Surgery, Zhongshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Zhongshan, China
| | - Xiao-Wen Huang
- Department of Ultrasonography, Zhongshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Zhongshan, China
| | - Xiao-Fang Chen
- Department of Nephrology, Zhongshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Zhongshan, China
| | - Yan-Feng Luo
- Department of Nephrology, Zhongshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Zhongshan, China
| | - Hai-Wen An
- Department of Nephrology, Zhongshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Zhongshan, China
| | - Jian-Lin Jian
- Department of Nephrology, Zhongshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Zhongshan, China
| | - Linna Liu
- Department of Nephrology, Zhongshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Zhongshan, China
| | - Yan-Lin Li
- Department of Nephrology, Zhongshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Zhongshan, China
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Lanthionine, a Novel Uremic Toxin, in the Vascular Calcification of Chronic Kidney Disease: The Role of Proinflammatory Cytokines. Int J Mol Sci 2021; 22:ijms22136875. [PMID: 34206780 PMCID: PMC8269354 DOI: 10.3390/ijms22136875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/24/2021] [Accepted: 06/23/2021] [Indexed: 12/14/2022] Open
Abstract
Vascular calcification (VC) is a risk factor for cardiovascular events and mortality in chronic kidney disease (CKD). Several components influence the occurrence of VC, among which inflammation. A novel uremic toxin, lanthionine, was shown to increase intracellular calcium in endothelial cells and may have a role in VC. A group of CKD patients was selected and divided into patients with a glomerular filtration rate (GFR) of <45 mL/min/1.73 m2 and ≥45 mL/min/1.73 m2. Total Calcium Score (TCS), based on the Agatston score, was assessed as circulating lanthionine and a panel of different cytokines. A hemodialysis patient group was also considered. Lanthionine was elevated in CKD patients, and levels increased significantly in hemodialysis patients with respect to the two CKD groups; in addition, lanthionine increased along with the increase in TCS, starting from one up to three. Interleukin IL-6, IL-8, and Eotaxin were significantly increased in patients with GFR < 45 mL/min/1.73 m2 with respect to those with GFR ≥ 45 mL/min/1.73 m2. IL-1b, IL-7, IL-8, IL-12, Eotaxin, and VEGF increased in calcified patients with respect to the non-calcified. IL-8 and Eotaxin were elevated both in the low GFR group and in the calcified group. We propose that lanthionine, but also IL-8 and Eotaxin, in particular, are a key feature of VC of CKD, with possible marker significance.
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Greene B, Kim SJ, McCarthy EP, Pasternak JD. Effects of Social Disparities on Management and Surgical Outcomes for Patients with Secondary Hyperparathyroidism. World J Surg 2020; 44:537-543. [PMID: 31570954 DOI: 10.1007/s00268-019-05207-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Nearly 80% of chronic renal failure patients have secondary hyperparathyroidism. Cinacalcet is used to lower parathyroid hormone; however, it is expensive and has side effects. When secondary hyperparathyroidism is resistant to medication or medications are inaccessible, parathyroidectomy is performed. Race and socioeconomic status influence access to care and surgical outcomes. We sought to evaluate the effect of race and socioeconomic status on parathyroidectomy rate as well as surgical outcomes of patients with secondary hyperparathyroidism. METHODS We undertook cross-sectional analysis of adults diagnosed with secondary hyperparathyroidism in the USA between 2012 and 2014, using the National Inpatient Sample. Univariate and multivariate analyses were used to determine associations between social disparities, likelihood to undergo parathyroidectomy, and surgical outcomes. RESULTS Between 2012 and 2014, a national estimate of 724,170 hospitalizations were identified where patients had a diagnosis of secondary hyperparathyroidism. Operative rate was 0.67%. By socioeconomic status, differences in rates of surgery in the poorest compared to the richest were not significant (0.74% vs. 0.55%, OR 1.08, p = 0.5). African-American patients had higher rates of parathyroidectomy compared to Caucasians (1 vs. 0.74%, OR 1.49, p < 0.001). African-American patients also had a trend toward more complications and greater length of stay. CONCLUSIONS According to a large administrative dataset, parathyroidectomy for secondary hyperparathyroidism is seldom used in the USA. African-American patients have higher rates of surgical management. Surgical outcomes may be affected by race. Clinicians treating secondary hyperparathyroidism should be aware of existing disparities within their health system.
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Affiliation(s)
- Brittany Greene
- Division of General Surgery, Department of Surgery, University Health Network, Toronto General Hospital, 10 En 214, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada
| | - S Joseph Kim
- Division of Nephrology, Department of Medicine, University Health Network, 585 University Avenue, 11-PMB-129, Toronto, ON, M5G 2N2, Canada
| | - Ellen P McCarthy
- Department of Epidemiology, Harvard School of Public Health, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Jesse D Pasternak
- Division of General Surgery, Department of Surgery, University Health Network, Toronto General Hospital, 10 En 214, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.
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Simeoni M, Perna AF, Fuiano G. Secondary Hyperparathyroidism and Hypertension: An Intriguing Couple. J Clin Med 2020; 9:jcm9030629. [PMID: 32120854 PMCID: PMC7141131 DOI: 10.3390/jcm9030629] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 02/19/2020] [Accepted: 02/21/2020] [Indexed: 12/20/2022] Open
Abstract
: Secondary hyperparathyroidism (SHPTH) is a major complication in patients on maintenance hemodialysis burdened with high cardiovascular risk. Hypertension is also a high prevalence complication contributing to an increase in the mortality rate in hemodialysis patients. A possible association between SHPTH and hypertension has been widely reported in the literature and several pathogenetic mechanisms have been described. There is evidence that the decrease of plasma iPTH levels are correlated with hypertension correction in hemodialysis patients undergoing parathyroidectomy and oral calcimimetics administration. We have observed a similar behaviour also in a patient on chronic hemodialysis treated with Etelcalcetide. Even if this is an isolated observation, it could stimulate future investigation, possibly in dedicated clinical trials.
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Affiliation(s)
- Mariadelina Simeoni
- Department of Translational Medical Sciences, University of Campania ‘Luigi Vanvitelli’, 80131 Naples, Italy;
- Correspondence: ; Tel.: +39-0815666652; Fax: +39-0815666821
| | - Alessandra F. Perna
- Department of Translational Medical Sciences, University of Campania ‘Luigi Vanvitelli’, 80131 Naples, Italy;
| | - Giorgio Fuiano
- Department of Medical and Surgery Sciences, ‘Magna Graecia University’, 88100 Catanzaro, Italy;
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Kim WW, Rhee Y, Kim BS, Kim K, Lee CR, Kang SW, Lee J, Jeong JJ, Nam KH, Chung WY. Clinical outcomes of parathyroidectomy versus cinacalcet in the clinical management of secondary hyperparathyroidism. Endocr J 2019; 66:881-889. [PMID: 31189770 DOI: 10.1507/endocrj.ej19-0036] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Parathyroidectomy (PTX) is the standard treatment for secondary hyperparathyroidism (SHPT); however, the administration of cinacalcet has gained prominence as a noninvasive treatment. We aimed to determine whether PTX or cinacalcet is more effective in preventing morbidity and mortality through reviewing follow-up data concerning surgical management of SHPT. We retrospectively analyzed and divided 209 patients with SHPT into two treatment groups: PTX (n = 78) and cinacalcet (n = 131) groups. We compared clinical features, the over-the-target range rate during pre- and post-intervention periods, new cardiovascular events, and all-cause mortality between both groups. Almost all biochemical parameters were well controlled in the post-intervention period, and were within the recommended target range for the PTX group but not for the cinacalcet group. A significant difference was observed in the over-the-target range rate during the post-intervention period between the groups. PTX and cinacalcet interventions significantly lowered the over-the-target range rates for serum intact parathyroid hormone (iPTH) (>300 pg/mL), corrected calcium (>10.5 mg/mL), serum phosphorus (>5.5 mg/dL), and calcium-phosphorus product (>55) in both groups (p = 0.001). PTX reduced the risk of new cardiovascular events by 86% compared to cinacalcet (p = 0.001); however, all-cause mortality did not differ significantly (14.1% vs. 7.6%, p = 0.132). For patients with SHPT, PTX helps prevent cardiovascular events through normalizing biochemical variables, according to recommended guidelines. PTX should be considered before cinacalcet treatment to prevent new cardiovascular events. Early PTX for appropriate patients can help prevent immediate postoperative complications and mortality.
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Affiliation(s)
- Won Woong Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yumie Rhee
- Department of Internal Medicine, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Beom Seok Kim
- Division of Nephrology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Kwangsoon Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Cho Rok Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Sang-Wook Kang
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jandee Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Ju Jeong
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Kee-Hyun Nam
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Woong Youn Chung
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
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Cardiovascular and Cerebrovascular Events After Parathyroidectomy in Patients on Renal Replacement Therapy. World J Surg 2019; 43:1981-1988. [PMID: 31087130 DOI: 10.1007/s00268-019-05020-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND A majority of patients with end-stage renal disease suffer from secondary hyperparathyroidism, which is associated with osteoporosis and cardiovascular disease. Parathyroidectomy (PTX) is often necessary despite medical treatment. However, the effect of PTX on cardio- and cerebrovascular events (CVE) remains unclear. Data on the effect of PTX from population-based studies are scarce. Some studies have shown decreased incidence of CVE after PTX. The aim of this study was to evaluate the effect of PTX on risk of CVE in patients on renal replacement therapy. METHODS We performed a nested case-control study within the Swedish Renal Registry (SRR) by matching PTX patients on dialysis or with functioning renal allograft with up to five non-PTX controls for age, sex and underlying renal disease. To calculate time to CVE, i.e., myocardial infarct, stroke and transient ischemic attack, control patients were assigned the calendar date (d) of the PTX of the case patient. Crude and adjusted proportional hazards regressions with random effect (frailty) were used to calculate hazard ratios for CVE. RESULTS The study cohort included 20,056 patients in the SRR between 1991 and 2009. Among these, 579 patients had undergone PTX, 423 during dialysis and 156 during time with functioning renal allograft. These patients were matched with 1234 dialysis and 736 transplanted non-PTX patients. The adjusted hazard ratio (HR) with 95% confidence interval (CI) of CVE after PTX was 1.24 (1.03-1.49) for dialysis patients compared with non-PTX patients. Corresponding results for patients with renal allograft at d were HR (95% CI) 0.53 (0.34-0.84). CONCLUSIONS PTX patients on dialysis at d had a higher risk of CVE than patients without PTX. Patients with renal allograft at d on the other had a lower risk after PTX than patients without PTX.
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Rodríguez-Ortiz ME, Pendón-Ruiz de Mier MV, Rodríguez M. Parathyroidectomy in dialysis patients: Indications, methods, and consequences. Semin Dial 2019; 32:444-451. [PMID: 30656752 DOI: 10.1111/sdi.12772] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Secondary hyperparathyroidism, characterized by increased PTH synthesis and secretion, is often seen in advanced stages of chronic kidney disease. Excessive proliferation of parathyroid cells leads to the development of diffuse hyperplasia that subsequently progresses to nodular histology. Refractory hyperparathyroidism occurs when parathyroid glands fail to respond to medical therapy. Parathyroidectomy (PTX), surgical resection of parathyroid glands, is usually performed in cases of persistent serum levels of PTH above 1000 pg/mL associated with hypercalcemia or when hyperparathyroidism is refractory to conservative therapy. Parathyroidectomy can be carried out using different procedures: subtotal PTX or total PTX with or without parathyroid autotransplantation. Parathyroid surgery may have undesirable consequences due to PTH oversuppression, such as the development of adynamic bone disease; hungry bone syndrome is quite common after this surgery. However, PTX improves survival and parameters of mineral metabolism. Parathyroidectomy needs to be considered in those patients with severe hyperparathyroidism with a poor response to pharmacological treatment and with distinct undesirable effects of PTH on bone and mineral metabolism parameters.
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Affiliation(s)
- María E Rodríguez-Ortiz
- Maimónides Institute for Biomedical Research (IMIBIC), Córdoba, Spain.,Reina Sofía University Hospital, Córdoba, Spain.,University of Córdoba, Córdoba, Spain.,Spanish Renal Research Network (REDinREN), Institute of Health Carlos III, Madrid, Spain
| | - María V Pendón-Ruiz de Mier
- Maimónides Institute for Biomedical Research (IMIBIC), Córdoba, Spain.,Reina Sofía University Hospital, Córdoba, Spain.,University of Córdoba, Córdoba, Spain.,Spanish Renal Research Network (REDinREN), Institute of Health Carlos III, Madrid, Spain
| | - Mariano Rodríguez
- Maimónides Institute for Biomedical Research (IMIBIC), Córdoba, Spain.,University of Córdoba, Córdoba, Spain.,Spanish Renal Research Network (REDinREN), Institute of Health Carlos III, Madrid, Spain.,Nephrology Service, University Hospital Reina Sofía, Córdoba, Spain
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Veyrat M, Fessi H, Haymann JP, Ronco P, Lacau St Guily J, Périé S. Conservative three-quarter versus subtotal seven-eighths parathyroidectomy in secondary hyperparathyroidism. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 136:63-68. [PMID: 30327179 DOI: 10.1016/j.anorl.2018.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE There is at present no consensus concerning surgical techniques for secondary hyperparathyroidism (SHPT) in end-stage renal disease (ESRD). Although both subtotal and total parathyroidectomy provide low rates of recurrence, they may induce hypoparathyroidism, damaging the bone and cardiovascular systems. The aim of our study was to compare 3/4 and 7/8 parathyroidectomy in this population and to discuss the potential benefit of more conservative treatment. STUDY DESIGN Prospective observational study in a university teaching hospital between 2010 and 2014. METHODS The study included 34 consecutive ESRD patients with SHPT: 19 underwent 3/4 parathyroidectomy (group A*3/4) and 15 underwent 7/8 parathyroidectomy (group B*7/8). Serum intact 1-84 PTH levels (before and 6 months after surgery) and hospital stay were compared between the two groups. RESULTS Before surgery, PTH levels were similar between the two groups. At month 6 following surgery, median PTH levels were significantly higher in group A*3/4 than in group B*7/8 (109 versus 24pg/mL, respectively; P<0.0006). Hospital stay was shorter in group A*3/4 (4.79 versus 6.80 days, respectively; P=0.008). Postoperative hypoparathyroidism requiring long-term calcium and 1alpha(OH) D3 treatment was reported in 5% of patients in group A*3/4 and 26% of patients in group B*7/8 (P=0.04). CONCLUSIONS In this preliminary study, 3/4 conservative parathyroidectomy seemed effective and safe, with less reported morbidity than 7/8 parathyroidectomy, as assessed by lower rates of irreversible hypoparathyroidism and shorter hospital stay. LEVEL OF EVIDENCE 3b, individual case-control study.
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Affiliation(s)
- M Veyrat
- Department of Otolaryngology Head and Neck Surgery, Tenon Hospital, Faculty of Medicine Sorbonne University, Assistance publique-Hôpitaux de Paris, AP-HP, 4, Rue de la Chine, 75020 Paris, France
| | - H Fessi
- Department of Nephrology-Dialysis, Tenon Hospital, Faculty of Medicine Sorbonne University, Assistance publique-Hôpitaux de Paris, AP-HP, 4, Rue de la Chine, 75020 Paris, France
| | - J-P Haymann
- Department of Functional Renal Explorations, Tenon Hospital, Faculty of Medicine Sorbonne University, Assistance publique-Hôpitaux de Paris, AP-HP, 4, Rue de la Chine, 75020 Paris, France
| | - P Ronco
- Department of Nephrology-Dialysis, Tenon Hospital, Faculty of Medicine Sorbonne University, Assistance publique-Hôpitaux de Paris, AP-HP, 4, Rue de la Chine, 75020 Paris, France
| | - J Lacau St Guily
- Department of Otolaryngology Head and Neck Surgery, Tenon Hospital, Faculty of Medicine Sorbonne University, Assistance publique-Hôpitaux de Paris, AP-HP, 4, Rue de la Chine, 75020 Paris, France
| | - S Périé
- Department of Otolaryngology Head and Neck Surgery, Tenon Hospital, Faculty of Medicine Sorbonne University, Assistance publique-Hôpitaux de Paris, AP-HP, 4, Rue de la Chine, 75020 Paris, France.
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Zebrafish, a Novel Model System to Study Uremic Toxins: The Case for the Sulfur Amino Acid Lanthionine. Int J Mol Sci 2018; 19:ijms19051323. [PMID: 29710830 PMCID: PMC5983689 DOI: 10.3390/ijms19051323] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/19/2018] [Accepted: 04/22/2018] [Indexed: 02/06/2023] Open
Abstract
The non-proteinogenic amino acid lanthionine is a byproduct of hydrogen sulfide biosynthesis: the third endogenous vasodilator gas, after nitric oxide and carbon monoxide. While hydrogen sulfide is decreased in uremic patients on hemodialysis, lanthionine is increased and has been proposed as a new uremic toxin, since it is able to impair hydrogen sulfide production in hepatoma cells. To characterize lanthionine as a uremic toxin, we explored its effects during the early development of the zebrafish (Danio rerio), a widely used model to study the organ and tissue alterations induced by xenobiotics. Lanthionine was employed at concentrations reproducing those previously detected in uremia. Light-induced visual motor response was also studied by means of the DanioVision system. Treatment of zebrafish embryos with lanthionine determined acute phenotypical alterations, on heart organogenesis (disproportion in cardiac chambers), increased heart beating, and arrhythmia. Lanthionine also induced locomotor alterations in zebrafish embryos. Some of these effects could be counteracted by glutathione. Lanthionine exerted acute effects on transsulfuration enzymes and the expression of genes involved in inflammation and metabolic regulation, and modified microRNA expression in a way comparable with some alterations detected in uremia. Lanthionine meets the criteria for classification as a uremic toxin. Zebrafish can be successfully used to explore uremic toxin effects.
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12
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El-Husseini A, Wang K, Edon A, Saxon D, Lima F, Sloan D, Sawaya BP. Value of Intraoperative Parathyroid Hormone Assay during Parathyroidectomy in Dialysis and Renal Transplant Patients with Secondary and Tertiary Hyperparathyroidism. Nephron Clin Pract 2017; 138:119-128. [PMID: 29131092 DOI: 10.1159/000482016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 10/05/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In dialysis and renal transplant patients with secondary and tertiary hyperparathyroidism (HPT), the value of intraoperative parathyroid hormone (ioPTH) during parathyroidectomy (PTX) and its association with long-term PTH levels are unknown. The present study aims at evaluating the relationship of ioPTH with long-term PTH levels post-PTX in dialysis and renal transplant patients in a single-center study. METHODS The ioPTH was measured in 57 dialysis patients (33 females and 24 males) and 18 renal transplant recipients (12 males and 6 females) who underwent PTX from 2005 to 2015 for refractory HPT. Near-total PTX was performed in 56 patients and total PTX with autotransplantation in 20 patients. The PTH monitoring included 3 samples: pre-intubation, 10- and 20-min (pre-ioPTH, 10-ioPTH, and 20-ioPTH) post parathyroid gland excision. Patients were followed up for up to 5 years. RESULTS In the dialysis group, the median (25th-75th percentile) pre-, 10-, and 20-ioPTH levels were 1,447 pg/mL (938-2,176), 143 pg/mL (78-244) and 112 pg/mL (59-153) respectively. In the renal transplant group, pre-, 10-, and 20-ioPTH levels were 273 pg/mL (180-403), 42 pg/mL (25-72), and 34 pg/mL (23-45) respectively. All patients in the transplant group had a functional kidney transplant at the time of PTX with a median serum creatinine of 1.3 mg/dL (1.2-1.7) and estimated glomerular filtration rate of 55 mL/min (40-60). The median time between renal transplant and PTX surgeries was 22 months (7-81). The last median follow-up PTH level was 66 pg/mL (15-201) in the dialysis group and 54 pg/mL (17-72) in the transplant group (p = 0.438). The mean time for last PTH post-PTX was 2.3 ± 2.0 years. In both groups, there was no significant difference between 20-ioPTH and any-time post-PTX PTH levels (p = 0.6 and p = 0.9). Nineteen patients (25%) were readmitted within 90 days because of hypocalcemia. One patient in the dialysis group was readmitted for post-PTX hematoma evacuation. No patient required repeat PTX because of recurrent HPT that was refractory to medical therapy. Only one dialysis patient required repeat PTX because the first procedure failed. CONCLUSIONS The 20-ioPTH is a good indicator of long-term PTH levels in dialysis and renal transplant patients. Hypocalcemia is a common complication, particularly in dialysis patients, and it is the main reason for readmission after PTX. Hypoparathyroidism is a potential concern after PTX in dialysis patients.
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Affiliation(s)
- Amr El-Husseini
- Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Lexington, Kentucky, USA.,Division of Nephrology, Mansoura University, Mansoura, Egypt
| | - Kevin Wang
- Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Lexington, Kentucky, USA
| | - Annick Edon
- Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Lexington, Kentucky, USA
| | - David Saxon
- Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Lexington, Kentucky, USA
| | - Florence Lima
- Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Lexington, Kentucky, USA
| | - David Sloan
- Section of Endocrine Surgery, University of Kentucky, Lexington, Kentucky, USA
| | - B Peter Sawaya
- Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Lexington, Kentucky, USA
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13
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Impact of surgical parathyroidectomy on chronic kidney disease-mineral and bone disorder (CKD-MBD) - A systematic review and meta-analysis. PLoS One 2017; 12:e0187025. [PMID: 29107998 PMCID: PMC5673225 DOI: 10.1371/journal.pone.0187025] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 09/06/2017] [Indexed: 01/11/2023] Open
Abstract
For more than 6 decades, many patients with advanced chronic kidney disease (CKD) have undergone surgical parathyroidectomy (sPTX) for severe secondary hyperparathyroidism (SHPT) mainly based historical clinical practice patterns, but not on evidence of outcome.We aimed in this meta-analysis to evaluate the benefits and harms of sPTX in patients with SHPT. We searched MEDLINE (inception to October 2016), EMBASE and Cochrane Library (through Issue 10 of 12, October 2016) and website clinicaltrials.gov (October 2016) without language restriction. Eligible studies evaluated patients reduced glomerular filtration rate (GFR), below 60 mL/min/1.73 m2 (CKD 3–5 stages) with hyperparathyroidism who underwent sPTX. Reviewers working independently and in duplicate extracted data and assessed the risk of bias. The final analysis included 15 cohort studies, comprising 24,048 participants. Compared with standard treatment, sPTX significantly decreased all-cause mortality (RR 0.74 [95% CI, 0.66 to 0.83]) in End Stage Kidney Disease (ESKD) patients with biochemical and / or clinical evidence of SHPT. sPTX was also associated with decreased cardiovascular mortality (RR 0.59 [95% CI, 0.46 to 0.76]) in 6 observational studies that included almost 10,000 patients. The available evidence, mostly observational, is at moderate risk of bias, and limited by indirect comparisons and inconsistency in reporting for some outcomes (eg. short term adverse events, including documented voice change or episodes of severe hypocalcaemia needing admission or long-term adverse events, including undetectable PTH levels, risk of fractures etc.). Taken together, the results of this meta-analysis would suggest a clinically significant beneficial effect of sPTX on all-cause and cardiovascular mortality in CKD patients with SHPT. However, given the observational nature of the included studies, the case for a properly conducted, independent randomised controlled trial comparing surgery with medical therapy and featuring many different outcomes from mortality to quality of life (QoL) is now very strong.
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14
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Di Crescenzo VG, Napolitano F, Panico C, Di Crescenzo RM, Zeppa P, Vatrella A, Laperuta P. Surgical approach in thymectomy: Our experience and review of the literature. Int J Surg Case Rep 2017; 39:19-24. [PMID: 28787670 PMCID: PMC5545819 DOI: 10.1016/j.ijscr.2017.07.028] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 07/18/2017] [Accepted: 07/18/2017] [Indexed: 11/30/2022] Open
Abstract
Aim Thymectomy is the main treatment for thymoma and patients with myasthenia gravis (MG). The traditional approach is through a median sternotomy, but, recently, thymectomy through minimally invasive approaches is increasingly performed. Our purpose is an analysis and discussion of the clinical presentation, the diagnostic procedures and the surgical technique. We also consider post-operative complications and results, over a period of 5 years (May 2011–June 2016), in thymic masses admitted in our Thoracic Surgery Unit. Methods We analyzed 8 patients who underwent surgical treatment for thymic masses over a period of 5 years. 6 patients (75%) had thymoma, 2 patients (25%) had thymic carcinomas. 2 patients with thymoma (33%) had myasthenia gravis. We performed a complete surgical resection with median sternotomy as standard approach. Results One patient (12%) died in the postoperative period. The histological study revealed 6 (75%) thymoma and 2 (25%) thymic carcinomas. Post-operative morbidity occurred in 2 patients (25%) and were: pneumonia in 1 case (12%), atrial fibrillation and pleural effusion in 2 patients (25%). One patient with thymoma type A recurred at skeletal muscle 2-years after surgery. Conclusions Thymic malignancies are rare tumors. Surgical resection is the main treatment, but a multimodal approach is useful for many patients. Radical thymectomy is completed removing all the soft tissue in the anterior mediastinum between the two phrenic nerves and this is the most important factor in controlling myasthenia and influencing survival in patients with thymoma. Open (median sternotomy) approach has been the standard approach for thymectomy for the better visualization of the anatomical structures. Actually, video-assisted thoracoscopic surgery (VATS) thymectomy and robotic video-assisted thoracoscopic (R-VATS) approach versus open surgery has an equal if not superior oncological efficacy, better perioperative complications and survival outcomes.
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Affiliation(s)
| | - Filomena Napolitano
- Department of Medicine and Surgery, Thoracic Surgery Unit, University of Salerno, Italy.
| | - Claudio Panico
- Department of Medicine and Surgery, Thoracic Surgery Unit, University of Salerno, Italy.
| | - Rosa Maria Di Crescenzo
- Department of Medicine and Surgery, Pathology Unit, Federico II University of Naples, Italy.
| | - Pio Zeppa
- Department of Medicine and Surgery, Pathology Unit, University of Salerno, Italy.
| | - Alessandro Vatrella
- Department of Medicine and Surgery, Section of Respiratory Diseases, University of Salerno, Salerno, Italy.
| | - Paolo Laperuta
- Department of Medicine and Surgery, Thoracic Surgery Unit, University of Salerno, Italy.
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15
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El-Husseini A, Wang K, Edon AA, Sawaya BP. Parathyroidectomy-A last resort for hyperparathyroidism in dialysis patients. Semin Dial 2017; 30:385-389. [DOI: 10.1111/sdi.12632] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Amr El-Husseini
- Division of Nephrology, Bone and Mineral Metabolism; University of Kentucky; Lexington KY USA
- Division of Nephrology; Mansoura University; Mansoura Egypt
| | - Kevin Wang
- Division of Nephrology, Bone and Mineral Metabolism; University of Kentucky; Lexington KY USA
| | - Adeleye Annick Edon
- Division of Nephrology, Bone and Mineral Metabolism; University of Kentucky; Lexington KY USA
| | - B. Peter Sawaya
- Division of Nephrology, Bone and Mineral Metabolism; University of Kentucky; Lexington KY USA
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16
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Cozzolino M, Galassi A, Conte F, Mangano M, Di Lullo L, Bellasi A. Treatment of secondary hyperparathyroidism: the clinical utility of etelcalcetide. Ther Clin Risk Manag 2017; 13:679-689. [PMID: 28615947 PMCID: PMC5461056 DOI: 10.2147/tcrm.s108490] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Secondary hyperparathyroidism (SHPT), a very frequent, severe, and worsening complication of chronic kidney disease, is characterized by high serum parathyroid hormone (PTH), parathyroid gland hyperplasia, and disturbances in mineral metabolism. Clinically, SHPT shows renal osteodystrophy, vascular calcification, cardiovascular damage, and fatal outcome. Calcium-sensing receptor (CaSR) is the main physiological regulator of PTH secretion; its activation by calcium rapidly inhibits PTH. Another important player in regulating mineral metabolism is vitamin D receptor (VDR), which is under the influence of vitamin D and influences the intestinal absorption of calcium and phosphate, PTH gene expression, and bone calcium mobilization. Serum phosphate levels influence fibroblast growth factor 23 (FGF-23) production, a phosphatonin that modulates serum phosphate reabsorption, PTH synthesis, and vitamin D production. Current therapeutic approaches consist of 1) phosphate intake control by diet or phosphate binders, 2) vitamin D by VDR activation, and 3) calcimimetic agents that activate CaSR. Recently, a new long-acting peptide (etelcalcetide) belonging to the calcimimetics class was approved for intravenous use in hemodialysis patients with SHPT. Etelcalcetide binds directly to CaSR, by a sulfide bond, inhibiting the production and secretion of PTH by parathyroid glands. After intravenous administration in rats, etelcalcetide is quickly distributed to the tissues and eliminated by kidneys, while in uremic animals the nonrenal excretion is only 1.2%. In hemodialysis patients, the treatment itself is the main route of elimination. Etelcalcetide in hemodialysis patients with SHPT was more effective than placebo and cinacalcet, with a PTH reduction of >30% in 76% of patients with etelcalcetide versus 10% with placebo. Particular attention was paid to the safety of the drug; the most common adverse event was asymptomatic blood calcium reduction, similar to cinacalcet, while gastrointestinal symptoms were less frequent. This promising new drug available for better control of SHPT will, together with drugs already in use, optimize the treatment to normalize the biochemical parameters.
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Affiliation(s)
- Mario Cozzolino
- Department of Health Sciences, Renal Division, University of Milan, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan
| | - Andrea Galassi
- Department of Health Sciences, Renal Division, University of Milan, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan
| | - Ferruccio Conte
- Department of Health Sciences, Renal Division, University of Milan, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan
| | - Michela Mangano
- Department of Health Sciences, Renal Division, University of Milan, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan
| | - Luca Di Lullo
- U.O.C. Nefrologia e Dialisi, Ospedale L. Parodi Delfino, Colleferro, Roma
| | - Antonio Bellasi
- Department of Health Sciences, Renal Division, University of Milan, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan
- Sant’Anna Hospital, ASST-Lariana, Como, Italy
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17
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van der Plas WY, Dulfer RR, Engelsman AF, Vogt L, de Borst MH, van Ginhoven TM, Kruijff S. Effect of parathyroidectomy and cinacalcet on quality of life in patients with end-stage renal disease-related hyperparathyroidism: a systematic review. Nephrol Dial Transplant 2017; 32:1902-1908. [DOI: 10.1093/ndt/gfx044] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 02/08/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Willemijn Y van der Plas
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Roderick R Dulfer
- Department of Surgery, Erasmus University, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Anton F Engelsman
- Department of Endocine Surgery, University of Sydney, Royal North Shore Hospital, Sydney, Australia
| | - Liffert Vogt
- Department of Internal Medicine and Nephrology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Martin H de Borst
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Tessa M van Ginhoven
- Department of Surgery, Erasmus University, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Schelto Kruijff
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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18
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Kurukahvecioglu O, Dikmen K, Bostanci H, Akin M, Taneri F. An Approach to Macroscopic Central Lymph Nodes Detected during Surgery in Patients with Thyroid Micropapillary Carcinoma: Should We Resort to Dissection? Int J Endocrinol 2017; 2017:5814610. [PMID: 28331494 PMCID: PMC5346366 DOI: 10.1155/2017/5814610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 12/27/2016] [Accepted: 01/30/2017] [Indexed: 11/18/2022] Open
Abstract
Background. High-resolution ultrasonography and the ability to perform fine-needle aspiration biopsy even for nodules smaller than three millimeters have considerably increased the detection rate of thyroid micropapillary carcinoma (TMPC). Despite favorable prognosis, the prevalence of cervical lymph node metastases in patients with TMPC is approximately 30%. Aim. In this study, we aimed to determine the central lymph node metastasis rate and its relation to the characteristics of the tumor. Methods. One hundred nine patients who underwent surgery due to TMPC between December 2009 and January 2014 were analyzed retrospectively. Patients were divided into two groups according to whether they underwent lymph node dissection and the two groups were then compared with respect to tumor size and multicentricity, age, and presence of lymphocytic thyroiditis. Results. There were no statistically significant differences between the two groups of patients in terms of tumor size, tumor multicentricity, age, and presence of lymphocytic thyroiditis. When the patient group that received lymph node dissection was further analyzed, it was found that patients with lymphocytic thyroiditis had a significantly lower number of metastatic lymph nodes. Conclusion. Central lymph node dissection in TMPC patients with macroscopic lymph node detected intraoperatively would ensure accurate staging without an increase in morbidity.
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Affiliation(s)
- Osman Kurukahvecioglu
- Department of General Surgery, Faculty of Medicine, Gazi University, Ankara, Turkey
- *Osman Kurukahvecioglu:
| | - Kursat Dikmen
- Department of General Surgery, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Hasan Bostanci
- Department of General Surgery, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Murat Akin
- Department of General Surgery, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ferit Taneri
- Department of General Surgery, Faculty of Medicine, Gazi University, Ankara, Turkey
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19
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Ma TL, Chang RY, Chen HJ, Liu CY, Hsu CC, Hsu YH. Risk of acute coronary syndrome after parathyroidectomy in patients with end-stage renal disease: A population-based cohort study in Taiwan. Nephrology (Carlton) 2016; 23:139-147. [PMID: 27790808 PMCID: PMC5817232 DOI: 10.1111/nep.12958] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 10/19/2016] [Accepted: 10/20/2016] [Indexed: 11/29/2022]
Abstract
Aim Patients with end‐stage renal disease (ESRD) who received parathyroidectomy (PTX) had persistently reduced levels of parathyroid hormone. This study investigated the risk of acute coronary syndrome (ACS) in patients with ESRD who underwent PTX using a nationwide health insurance claims database. Methods Of all ESRD patients, we selected 1047 individuals who had undergone PTX between 2000 and 2008 as the PTX group and 4188 patients who did not undergo PTX (non‐PTX group) matched by propensity score. Multivariable Cox proportional hazards regression analysis was conducted for assessing the excess ACS risk for the PTX group compared to the non‐PTX group. Results The mean follow‐up periods were 4.63 and 4.04 years for the PTX and non‐PTX groups, respectively. A significant reduction in the risk of ACS (adjusted hazard ratio = 0.74, 95% confidence interval = 0.57–0.96) was observed for the ESRD patients after PTX. Conclusions Parathyroidectomy is associated with reduced risk of ACS in patients with ESRD. From a national health insurance claims database, this study matched patients receiving dialysis who had a parathyroidectomy to patients who did not, using a propensity score method. They demonstrate that patients who had a parathyroidectomy were less likely to experience an acute coronary syndrome in the ensuing 4 years.
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Affiliation(s)
- Tsung Liang Ma
- Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Rei Yeuh Chang
- Division of Cardiology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan.,Chung Jen Junior College of Nursing, Health Sciences and Management, Chiayi, Taiwan.,Department of Beauty and Health Care, Min-Hwei Junior College of Health Care Management, Tainan, Taiwan
| | - Hsuan Ju Chen
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,Department of College of Medicine, China Medical University, Taichung, Taiwan
| | - Chun Yi Liu
- Department of Public Health and Department of Health Services Administration, China Medical University, Taichung, Taiwan.,Department of Education, China Medical University Hospital, Taichung, Taiwan
| | - Chih Cheng Hsu
- Department of Health Services Administration, China Medical University, Taichung, Taiwan.,Institute of Population Health Sciences, National Health Research Institutes, Zhunane, Miaoli, Taiwan
| | - Yueh Han Hsu
- Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan.,Department of Medical Research, China Medical University Hospital and China Medical University, Taichung, Taiwan.,Department of Nursing, Min-Hwei Junior College of Health Care Management, Tainan, Taiwan
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20
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Jeong S, Kim IW, Oh KH, Han N, Joo KW, Kim HJ, Oh JM. Pharmacogenetic analysis of cinacalcet response in secondary hyperparathyroidism patients. DRUG DESIGN DEVELOPMENT AND THERAPY 2016; 10:2211-25. [PMID: 27468225 PMCID: PMC4944925 DOI: 10.2147/dddt.s103370] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Secondary hyperparathyroidism (SHPT) is one of the major risk factors of morbidity and mortality in end-stage renal disease. Cinacalcet effectively controls SHPT without causing hypercalcemia and hyperphosphatemia. However, there is significant inter-individual response variance to cinacalcet treatment. Therefore, we aimed to evaluate the genetic effects related with parathyroid hormone regulation as factors for cinacalcet response variance. Methods Patients with a diagnosis of SHPT based on intact parathyroid hormone (iPTH) >300 pg/mL on dialysis were included in this study. They were over 18 years and have been treated by cinacalcet for more than 3 months. Responders and nonresponders were grouped by the serum iPTH changes. Twenty-four single nucleotide polymorphisms of CASR, VDR, FGFR1, KL, ALPL, RGS14, NR4A2, and PTHLH genes were selected for the pharmacogenetic analysis. Results After adjusting for age, sex, and calcium level, CASR rs1042636 (odds ratio [OR]: 0.066, P=0.027) and rs1802757 (OR: 10.532, P=0.042) were associated with cinacalcet response. The association of haplotypes of CASR rs1042636, rs10190, and rs1802757; GCC (OR: 0.355, P=0.015); and ATT (OR: 2.769, P=0.014) with cinacalcet response was also significant. Conclusion We obtained supporting information of the associations between cinacalcet response and CASR polymorphisms. CASR single nucleotide polymorphisms (SNPs) rs1802757, rs1042636, and haplotypes of rs1042636, rs10190, and rs1802757 were significantly associated with cinacalcet response variance.
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Affiliation(s)
- Sohyun Jeong
- College of Pharmacy, Research Institute of Pharmaceutical Sciences, Seoul National University
| | - In-Wha Kim
- College of Pharmacy, Research Institute of Pharmaceutical Sciences, Seoul National University
| | - Kook-Hwan Oh
- Department of Internal Medicine, Division of Nephrology, Seoul National University Hospital, Seoul, Korea
| | - Nayoung Han
- College of Pharmacy, Research Institute of Pharmaceutical Sciences, Seoul National University
| | - Kwon Wook Joo
- Department of Internal Medicine, Division of Nephrology, Seoul National University Hospital, Seoul, Korea
| | - Hyo Jin Kim
- Department of Internal Medicine, Division of Nephrology, Seoul National University Hospital, Seoul, Korea
| | - Jung Mi Oh
- College of Pharmacy, Research Institute of Pharmaceutical Sciences, Seoul National University
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21
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Hsu YH, Yu HY, Chen HJ, Li TC, Hsu CC, Kao CH. The Risk of Peripheral Arterial Disease after Parathyroidectomy in Patients with End-Stage Renal Disease. PLoS One 2016; 11:e0156863. [PMID: 27284924 PMCID: PMC4902219 DOI: 10.1371/journal.pone.0156863] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 05/17/2016] [Indexed: 11/21/2022] Open
Abstract
Purpose The changes of the risk of peripheral arterial disease (PAD) in patients with end-stage renal disease after parathyroidectomy are scant. Methods We used a nationwide health insurance claims database to select all dialysis-dependent patients with end-stage renal disease aged 18 years and older for the study population in 2000 to 2006. Of the patients with end-stage renal disease, we selected 947 patients who had undergone parathyroidectomy as the parathyroidectomy group and frequency matched 3746 patients with end-stage renal disease by sex, age, years since the disease diagnosis, and the year of index date as the non-parathyroidectomy group. We used a multivariate Cox proportional hazards regression analysis with the use of a robust sandwich covariance matrix estimate, accounting for the intra-cluster dependence of hospitals or clinics, to measure the risk of peripheral arterial disease for the parathyroidectomy group compared with the non-parathyroidectomy group after adjusting for sex, age, premium-based income, urbanization, and comorbidity. Results The mean post-op follow-up periods were 5.08 and 4.52 years for the parathyroidectomy and non-parathyroidectomy groups, respectively; the incidence density rate of PAD in the PTX group was 12.26 per 1000 person-years, significantly lower than the data in the non-PTX group (24.09 per 1000 person-years, adjusted HR = 0.66, 95% CI = 0.46–0.94). Conclusion Parathyroidectomy is associated with reduced risk of peripheral arterial disease in patients with end-stage renal disease complicated with severe secondary hyperparathyroidism.
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Affiliation(s)
- Yueh-Han Hsu
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
- Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
- Department of Nursing, Min-Hwei Junior College of Health Care Management, Tainan, Taiwan
| | - Hui-Yi Yu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yiy, Taiwan
- Department of Sports Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Hsuan-Ju Chen
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Tsai-Chung Li
- Graduate Institute of Biostatistics, College of Public Health, China Medical University, Taichung, Taiwan
- Department of Healthcare Administration, College of Health Science, Asia University, Taichung, Taiwan
| | - Chih-Cheng Hsu
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
- * E-mail:
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22
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Chen L, Wang K, Yu S, Lai L, Zhang X, Yuan J, Duan W. Long-term mortality after parathyroidectomy among chronic kidney disease patients with secondary hyperparathyroidism: a systematic review and meta-analysis. Ren Fail 2016; 38:1050-8. [PMID: 27198474 DOI: 10.1080/0886022x.2016.1184924] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Parathyroidectomy (PTx) and medical treatments are both recommended for reducing serum intact parathyroid hormone (iPTH) and curing secondary hyperparathyroidism (sHPT) in patients with chronic kidney disease (CKD), but their therapeutic effects on long-term mortality are not well-known. Thus, we aim to assess such therapeutic effect of PTx. Electronic literatures published on Pubmed, Embase, and Cochrane Central Register of Controlled Trials in any language until 27 November 2015 were systematically searched. All literatures that compared outcomes (survival rate or mortality rate) between PTx-treated and medically-treated CKD patients with sHPT were included. Finally, 13 cohort studies involving 22053 patients were included. Data were extracted from all included literatures in a standard form. The outcomes of all-cause and cardiovascular mortalities were assessed using DerSimonian and Laird's random effects model. We find PTx-treated versus medically-treated patients had a 28% reduction in all-cause mortality and a 37% reduction in cardiovascular mortality. Thus, PTx versus medical treatments might reduce the risks of all-cause and cardiovascular mortalities in CKD patients with sHPT. Further studies with prospective and large-sample clinical trials are needed to find out the real effect of PTx and to assess whether mortality rates differ among patterns of PTx.
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Affiliation(s)
- Lin Chen
- a Department of Endocrinology, Yantai Hospital of Traditional Chinese Medicine , Shandong University of Traditional Chinese Medicine , Yantai , Shandong , PR China
| | - Kongbo Wang
- b Department of Interventional Vascular Surgery, Yantai Hospital of Traditional Chinese Medicine , Shandong University of Traditional Chinese Medicine , Yantai , Shandong , PR China
| | - Shanlan Yu
- c Endoscopy Room, Yantai Hospital of Traditional Chinese Medicine , Shandong University of Traditional Chinese Medicine , Yantai , Shandong , PR China
| | - Liping Lai
- d Department of Cardiology , People's Hospital of Shouguang , Weifang , Shandong , PR China
| | - Xiaoping Zhang
- e Department of the PLA , Jinan Military Region Air Force Aftermath Work Office of out-Patient, ENT , Jinan , Shandong , PR China
| | - Jingjing Yuan
- f Department of Endocrinology , The People's Liberation Army 107th Hospital , Yantai , Shandong , PR China
| | - Weifeng Duan
- g Department of Periphery Vascular Surgery, Yantai Hospital of Traditional Chinese Medicine , Shandong University of Traditional Chinese Medicine , Yantai , Shandong , PR China
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23
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Ho LC, Hung SY, Wang HH, Kuo TH, Chang YT, Tseng CC, Wu JL, Li CY, Wang JD, Tsai YS, Sung JM. Parathyroidectomy Associates with Reduced Mortality in Taiwanese Dialysis Patients with Hyperparathyroidism: Evidence for the Controversy of Current Guidelines. Sci Rep 2016; 6:19150. [PMID: 26758515 PMCID: PMC4725823 DOI: 10.1038/srep19150] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 11/26/2015] [Indexed: 12/19/2022] Open
Abstract
Parathyroidectomy is recommended by the clinical guidelines for dialysis patients with unremitting secondary hyperparathyroidism (SHPT). However, the survival advantage of parathyroidectomy is debated because of the selection bias in previous studies. To minimize potential bias in the present nationwide cohort study, we enrolled only dialysis patients who had undergone radionuclide parathyroid scanning to ensure all patients had severe SHPT. The parathyroidectomized patients were matched with the controls based on propensity score for parathyroidectomy. Mortality hazard was estimated using multivariate Cox proportional hazard models adjusting for comorbidities before scanning (model 1) or over the whole study period (model 2). Our results showed that among the 2786 enrolled patients, 1707 underwent parathyroidectomy, and the other 1079 were controls. The crude mortality rates were lower in the parathyroidectomized patients than in the controls. In adjusted analyses for the population matched on propensity score, parathyroidectomy was associated with a significant 20% to 25% lower risk for all-cause mortality (model 1: hazard ratio 0.76, 95% confidence interval 0.61 to 0.94; model 2: hazard ratio 0.80, 95% confidence internal 0.64 to 0.98). We concluded that parathyroidectomy was associated with a reduced long-term mortality risk in dialysis patients with severe SHPT.
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Affiliation(s)
- Li-Chun Ho
- Graduate Institute of Clinical Medicine, National Cheng Kung University, Tainan.,Division of Nephrology, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung
| | - Shih-Yuan Hung
- Division of Nephrology, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung
| | - Hsi-Hao Wang
- Division of Nephrology, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung
| | - Te-Hui Kuo
- Department of Internal Medicine, National Cheng Kung University Medical College and Hospital, Tainan.,Graduate Institute of Public Health, National Cheng Kung University, Tainan
| | - Yu-Tzu Chang
- Graduate Institute of Clinical Medicine, National Cheng Kung University, Tainan.,Department of Internal Medicine, National Cheng Kung University Medical College and Hospital, Tainan
| | - Chin-Chung Tseng
- Department of Internal Medicine, National Cheng Kung University Medical College and Hospital, Tainan
| | - Jia-Ling Wu
- Department of Internal Medicine, National Cheng Kung University Medical College and Hospital, Tainan
| | - Chung-Yi Li
- Department of Public Health, National Cheng Kung University College of Medicine, Tainan.,Department of Public Health, College of Public Health, China Medical University, Taichung
| | - Jung-Der Wang
- Department of Internal Medicine, National Cheng Kung University Medical College and Hospital, Tainan.,Department of Public Health, National Cheng Kung University College of Medicine, Tainan.,Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Yau-Sheng Tsai
- Graduate Institute of Clinical Medicine, National Cheng Kung University, Tainan
| | - Junne-Ming Sung
- Department of Internal Medicine, National Cheng Kung University Medical College and Hospital, Tainan
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Ivarsson KM, Akaberi S, Isaksson E, Reihnér E, Rylance R, Prütz KG, Clyne N, Almquist M. The effect of parathyroidectomy on patient survival in secondary hyperparathyroidism. Nephrol Dial Transplant 2015; 30:2027-33. [PMID: 26374600 PMCID: PMC4832998 DOI: 10.1093/ndt/gfv334] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 08/18/2015] [Accepted: 08/18/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Secondary hyperparathyroidism is a common condition in patients with end-stage renal disease and is associated with osteoporosis and cardiovascular disease. Despite improved medical treatment, parathyroidectomy (PTX) is still necessary for many patients on renal replacement therapy. The aim of this study was to evaluate the effect of PTX on patient survival. METHODS A nested index-referent study was performed within the Swedish Renal Registry (SRR). Patients on maintenance dialysis and transplantation at the time of PTX were analysed separately. The PTX patients in each of these strata were matched for age, sex and underlying renal diseases with up to five referent patients who had not undergone PTX. To calculate survival time and hazard ratios, indexes and referents were assigned the calendar date (d) of the PTX of the index patient. The risk of death after PTX was calculated using crude and adjusted Cox proportional hazards regressions. RESULTS There were 20 056 patients in the SRR between 1991 and 2009. Of these, 579 (423 on dialysis and 156 with a renal transplant at d) incident patients with PTX were matched with 1234/892 non-PTX patients. The adjusted relative risk of death was a hazard ratio (HR) of 0.80 [95% confidence interval (CI) 0.65-0.99] for dialysis patients at d who had undergone PTX compared with matched patients who had not. Corresponding results for the patients with a renal allograft at d were an HR of 1.10 (95% CI 0.71-1.70). CONCLUSIONS PTX was associated with improved survival in patients on maintenance dialysis but not in patients with renal allograft.
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Affiliation(s)
| | - Shahriar Akaberi
- Department of Nephrology and Transplantation, Skane University Hospital Lund, Skåne, Sweden
| | | | - Eva Reihnér
- Department of Molecular Medicine and Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Rebecca Rylance
- National Registry Centre, Skane University Hospital Lund, Skåne, Sweden
| | - Karl-Göran Prütz
- Department of Internal Medicine, Helsingborg Hospital, Helsingborg, Sweden
| | - Naomi Clyne
- Department of Nephrology and Transplantation, Skane University Hospital Lund, Skåne, Sweden
| | - Martin Almquist
- Department of Surgery Section of Endocrine and Sarcoma, Skane University Hospital, Lund, Skåne, Sweden
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25
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Lorenz K, Bartsch DK, Sancho JJ, Guigard S, Triponez F. Surgical management of secondary hyperparathyroidism in chronic kidney disease--a consensus report of the European Society of Endocrine Surgeons. Langenbecks Arch Surg 2015; 400:907-27. [PMID: 26429790 DOI: 10.1007/s00423-015-1344-5] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Accepted: 09/18/2015] [Indexed: 12/28/2022]
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.
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Affiliation(s)
- Kerstin Lorenz
- Department of General-, Visceral-, and Vascular Surgery, Martin-Luther University of Halle-Wittenberg, Ernst-Grube-Str. 40, Halle (Saale), 06120, Germany.
| | - Detlef K Bartsch
- Department of Visceral, Thoracic and Vascular Surgery, Philipps University Marburg, Baldingerstraße 1, Marburg, 35043, Germany.
| | - Juan J Sancho
- Department of General Surgery, Endocrine Surgery Unit, Hospital del Mar, Universitat Autònoma de Barcelona, Passeig Marítim 25-29, Barcelona, 08003, Spain.
| | - Sebastien Guigard
- Department of Thoracic and Endocrine Surgery, University Hospitals of Geneva, Switzerland, Rue Gabrielle Perret-Gentil 4, 14, Geneva, 1211, Switzerland.
| | - Frederic Triponez
- Chirurgie thoracique et endocrinienne, Hôpitaux Universitaires de Genève, Rue Gabrielle Perret-Gentil 4, 14, Geneva, 1211, Switzerland.
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Jing Y, Zhao H, Ge Y, Jia F, He Q, Wang S, Meng J. Application of total parathyroidectomy with auto-transplantation for uremia secondary hyperparathyroidism treatment. Int J Clin Exp Med 2015; 8:11188-11194. [PMID: 26379922 PMCID: PMC4565305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 07/12/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Secondary hyperparathyroidism (sHPT) is a common acquired disorder in patients with chronic renal failure. Despite the development of new therapeutic agents, a majority of patients will require parathyroidectomy. The aim of this study was to evaluate total parathyroidectomy with auto-transplantation of trace amounts of parathyroid tissue as a surgical option in uremia sHPT treatment. METHODS Clinical data of 50 sHPT patients who underwent total parathyroidectomy with auto-transplantation between January 2011 and December 2013 were reviewed retrospectively. Symptoms such as bone pain and fractures, concentrations of intact parathyroid hormone (iPTH), levels of ionized calcium and serum phosphorus, and activity of alkaline phosphatase were recorded before and after parathyroidectomy. RESULTS After operation, signs of pruritus, bone pain and muscle weakness was disappeared, iPTH level and serum phosphate concentration were declined markedly. No serious postoperative complications were observed. Follow-up observation was around 28 months. One female patient (2%) died 3 months after surgery due to heart failure, and another patient (2%) had persistent disease. All other patients recovered during the follow-up period. CONCLUSIONS Total parathyroidectomy with auto-transplantation of trace amounts of parathyroid tissue was considered to be a feasible, safe and effective surgical option for the treatment of sHPT.
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Affiliation(s)
- Ying Jing
- Department of Blood Purification, General Hospital of Jinan Military Command of The PLANo. 25 Shifan Road, Jinan, Shandong, 250031, People’s Republic of China
| | - Hanhui Zhao
- Department of Blood Purification, General Hospital of Jinan Military Command of The PLANo. 25 Shifan Road, Jinan, Shandong, 250031, People’s Republic of China
| | - Yanming Ge
- Department of Blood Purification, General Hospital of Jinan Military Command of The PLANo. 25 Shifan Road, Jinan, Shandong, 250031, People’s Republic of China
| | - Fengyu Jia
- Department of Blood Purification, General Hospital of Jinan Military Command of The PLANo. 25 Shifan Road, Jinan, Shandong, 250031, People’s Republic of China
| | - Qingqing He
- Department of Thyroid and Breast Surgery, General Hospital of Jinan Military Command of The PLANo. 25 Shifan Road, Jinan, Shandong, 250031, People’s Republic of China
| | - Suxia Wang
- Department of Blood Purification, General Hospital of Jinan Military Command of The PLANo. 25 Shifan Road, Jinan, Shandong, 250031, People’s Republic of China
| | - Jianzhong Meng
- Department of Blood Purification, General Hospital of Jinan Military Command of The PLANo. 25 Shifan Road, Jinan, Shandong, 250031, People’s Republic of China
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27
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Rodríguez M, Rodríguez-Ortiz ME. Advances in pharmacotherapy for secondary hyperparathyroidism. Expert Opin Pharmacother 2015; 16:1703-16. [DOI: 10.1517/14656566.2015.1061994] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Hsu YH, Chen HJ, Shen SC, Tsai WC, Hsu CC, Kao CH. Reduced Stroke Risk After Parathyroidectomy in End-Stage Renal Disease: A 13-Year Population-Based Cohort Study. Medicine (Baltimore) 2015; 94:e936. [PMID: 26061321 PMCID: PMC4616473 DOI: 10.1097/md.0000000000000936] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Research information on the risk of stroke in patients with dialysis-dependent end-stage renal disease (ESRD) who have undergone parathyroidectomy (PTX) is scant. We used a nationwide health insurance claims database to select all patients with dialysis-dependent ESRD age 18 years and older for the study population. Of the patients with ESRD, we selected 1083 patients who had undergone PTX between 1998 and 2006 as the PTX group and frequency-matched 1083 patients with ESRD by sex, age, years since the disease diagnosis, and the year of undergoing PTX as the non-PTX group. We used a multivariate Cox proportional hazards regression analysis to measure the risk of stroke for the PTX group compared with the non-PTX group after adjusting for sex, age, premium-based income, urbanization, and comorbidity. The mean follow-up periods were 6.08 and 5.38 years for the PTX and non-PTX groups, respectively. After adjusting for previously mentioned variables, significant risk reductions of stroke (adjusted hazard ratio = 0.57, 95% confidence interval = 0.41-0.79), particularly those of hemorrhagic stroke (adjusted hazard ratio = 0.34, 95% confidence interval = 0.20-0.57), with PTX were observed. Chronologically, the risk of stroke in the PTX group decreased in the second year after PTX and persisted for >3 years. PTX reduces the risk of stroke, particularly that of hemorrhagic stroke, in patients with dialysis-dependent ESRD. Other factors for risk reduction include sex (females), an age <65 years, and the presence of comorbidity.
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Affiliation(s)
- Yueh-Han Hsu
- From the Department of Public Health and Department of Health Services Administration, China Medical University, Taichung City (Y-HH, S-CS, W-CT); Department of Internal Medicine, Division of Nephrology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City (Y-HH); Department of Nursing, Min-Hwei Junior College of Health Care Management, Tainan City (Y-HH); Management Office for Health Data, China Medical University Hospital, Taichung City (H-JC); College of Medicine, China Medical University, Taichung City (H-JC); Department of Medical Affairs, Buddhist Dalin Tzu Chi Hospital, Chiayi (S-CS); Department of Health Services Administration, Chia Nan University of Pharmacy & Science, Tainan (S-CS); Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County (C-CH); Department of Health Services Administration, China Medical University and Hospital, Taichung City (C-CH); Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung City (C-HK); and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung City (C-HK), Taiwan
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Cozzolino M, Tomlinson J, Walsh L, Bellasi A. Emerging drugs for secondary hyperparathyroidism. Expert Opin Emerg Drugs 2015; 20:197-208. [PMID: 25702624 DOI: 10.1517/14728214.2015.1018177] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Secondary hyperparathyroidism (SHPT), a common, serious, and progressive complication of chronic kidney disease (CKD), is characterized by elevated serum parathyroid hormone (PTH), parathyroid gland hyperplasia, and mineral metabolism abnormalities. These disturbances may result in CKD-mineral and bone disorder (CKD-MBD), which is associated with poor quality of life and short life expectancy. AREAS COVERED The goal of SHPT treatment is to maintain PTH, calcium, and phosphorus within accepted targeted ranges. This review highlights the pathogenesis of SHPT and current SHPT therapeutic approaches, including the use of low-phosphate diets, phosphate binders, 1,25-dihydroxyvitamin D3 (calcitriol) and its analogs, calcimimetics, and parathyroidectomy in addition to discussing emerging drugs in development for SHPT. EXPERT OPINION Numerous studies indicate that mineral abnormalities occur early in the course of CKD, are prevalent by the time patients enter dialysis, and foreshadow a risk of cardiovascular and all-cause mortality. Several newly developed compounds may potentially overcome the limitations of current SHPT therapies. If emerging therapies can reduce PTH, normalize mineral metabolism, promote treatment adherence, and reduce the risk of side effects, they may provide the requisite features for improving long-term outcomes in patients with SHPT receiving dialysis and reduce the risks of CKD-MBD.
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Affiliation(s)
- Mario Cozzolino
- University of Milan, San Paolo Hospital, School of Medicine, Renal Division, Department of Health Sciences , Milan , Italy +39 02 81844381 ;
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Conzo G, Avenia N, Bellastella G, Candela G, de Bellis A, Esposito K, Pasquali D, Polistena A, Santini L, Sinisi AA. The role of surgery in the current management of differentiated thyroid cancer. Endocrine 2014; 47:380-8. [PMID: 24718845 DOI: 10.1007/s12020-014-0251-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 03/24/2014] [Indexed: 10/25/2022]
Abstract
In the last decades, a surprising increased incidence of differentiated thyroid cancer (DTC), along with a precocious diagnosis of "small" tumors and microcarcinomas have been observed. In these cases, better oncological outcomes are expected, and a "tailored" and "less aggressive" multimodal therapeutic protocol should be considered, avoiding an unfavorable even if minimal morbidity following an "overtreatment." In order to better define the most suitable surgical approach, its benefits and risks, we discuss the role of surgery in the current management of DTCs in the light of data appeared in the literature. Even if lymph node metastases are commonly observed, and in up to 90 % of DTC cases micrometastases are reported, the impact of lymphatic involvement on long-term survival is still argument of intensive research, and indications and extension of lymph node dissection (LD) are still under debate. In particular, endocrine and neck surgeons are still divided between proponents and opponents of routine central LD (RCLD). Considering the available evidence, there is agreement about total thyroidectomy, therapeutic LD in clinically node-positive DTC patients, and RCLD in "high risk" cases. Nevertheless, indications to the best surgical treatment of clinically node-negative "low risk" patients are still subject of research. Considering on the one hand, the recent trend toward routine central lymphadenectomy, avoiding radioactive treatment, and on the other hand, the satisfactory results obtained reserving prophylactic LD to "high risk" patients, we think that further prospective randomized trials are needed to evaluate the best choice between the different surgical approaches.
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Affiliation(s)
- Giovanni Conzo
- VII Division of General and Endocrine Surgery, Department of Anesthesiologic, Surgical and Emergency Sciences, School of Medicine, Second University of Naples, Via Sergio Pansini 5, 80131, Naples, Italy,
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31
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Conzo G, Della Pietra C, Tartaglia E, Gambardella C, Mauriello C, Palazzo A, Santini L, Fei L, Rossetti G, Docimo G, Perna A. Long-term function of parathyroid subcutaneous autoimplantation after presumed total parathyroidectomy in the treatment of secondary hyperparathyroidism. A clinical retrospective study. Int J Surg 2014; 12 Suppl 1:S165-9. [PMID: 24866066 DOI: 10.1016/j.ijsu.2014.05.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 05/03/2014] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Parathyroidectomy (PTx) is recommended in patients affected by secondary hyperparathyroidism (2HPT) of chronic kidney disease-mineral bone disorders (CKD-MBD), resistant to medical treatment. Analyzing total parathyroidectomy with muscular or subcutaneous autoimplantation (TPai) outcomes in hemodialysis (HD) 2HPT patients, and monitoring intact parathyroid hormone (iPTH) levels, we evaluated long-term functional results of subcutaneous parathyroid glandular tissue autoimplantation. METHODS 40 HD 2HPT patients, resistant to medical treatment, and awaiting for renal transplantation, underwent total parathyroidectomy with subcutaneous autoimplantation of 9-12 fragments of not nodular hyperplasia parathyroid tissue in not dominant forearm. iPTH were analyzed 24 h, and 3-6-12-24 months after surgery. The 1.08-6.99 pmol/L range was taken as reference of normal iPTH level based on which eu- (1.08-6.99), hypo- (<1.08), aparathyroidism (0) and persistence or relapse (>6.99) of disease were determined. RESULTS In every case PTai determined an extraordinary improvement of quality of life, associated with a notable reduction of iPTH serum level. Immediate normalization of iPTH was achieved in 50% of cases; hypoparathyroidism in 25% of cases and persistence of disease in 25% were observed. Long term follow-up showed a reduction of hypoparathyroidism and an increase of relapse rate up to 20%. Grafting resection was never performed. DISCUSSION Subcutaneous autotrasplantation is a very simple and fast surgical technique. Nevertheless, similar success and recurrence rates were reported following muscular or subcutaneous grafting, as confirmed in our experience. CONCLUSIONS Subcutaneous grafting was effective as muscular implantation, with comparable functional results, but avoiding its potential complications.
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Affiliation(s)
- G Conzo
- Department of Anaesthesiologic, Surgical and Emergency Science, VII Division of General Surgery, Second University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy.
| | - C Della Pietra
- Department of Anaesthesiologic, Surgical and Emergency Science, VII Division of General Surgery, Second University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy.
| | - E Tartaglia
- Department of Anaesthesiologic, Surgical and Emergency Science, VII Division of General Surgery, Second University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy.
| | - C Gambardella
- Department of Anaesthesiologic, Surgical and Emergency Science, VII Division of General Surgery, Second University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy.
| | - C Mauriello
- Department of Anaesthesiologic, Surgical and Emergency Science, VII Division of General Surgery, Second University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy.
| | - A Palazzo
- Department of Anaesthesiologic, Surgical and Emergency Science, VII Division of General Surgery, Second University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy.
| | - L Santini
- Department of Anaesthesiologic, Surgical and Emergency Science, VII Division of General Surgery, Second University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy.
| | - L Fei
- Unit of General Surgery and Digestive Physiopathology - "F. Magrassi-A. Lanzara", Department of Clinical and Experimental Medicine and Surgery, Second University of Naples, Via Pansini 5, 80131 Naples, Italy.
| | - G Rossetti
- Unit of General Surgery and Digestive Physiopathology - "F. Magrassi-A. Lanzara", Department of Clinical and Experimental Medicine and Surgery, Second University of Naples, Via Pansini 5, 80131 Naples, Italy.
| | - G Docimo
- Department of Anaesthesiologic, Surgical and Emergency Science, VII Division of General Surgery, Second University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy.
| | - A Perna
- Department of Cardio-thoracic and Respiratory Sciences First Division of Nephrology, Second University of Naples, Italy.
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He Q, Zhuang D, Zheng L, Fan Z, Zhou P, Zhu J, Duan S, Li Y, Ge Y, Lv Z, Cao L. Total parathyroidectomy with trace amounts of parathyroid tissue autotransplantation as the treatment of choice for secondary hyperparathyroidism: a single-center experience. BMC Surg 2014; 14:26. [PMID: 24886230 PMCID: PMC4021022 DOI: 10.1186/1471-2482-14-26] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Accepted: 04/25/2014] [Indexed: 12/31/2022] Open
Abstract
Background The aim of the study was to evaluate total parathyroidectomy with trace amounts of parathyroid tissue (30 mg) as a surgical option in secondary hyperparathyroidism (sHPT) treatment. Methods From January 2008 to March 2012, 47 patients underwent parathyroidectomy. Comparisons of demographic data, symptoms, and preoperative or postoperative biochemistry were made between total parathyroidectomy with trace amounts of parathyroid tissue autotransplantation group and total parathyroidectomy group. Results Out of 47 cases, 45 had successful operation. 187 parathyroid glands identified at the initial operation were reported in 47 patients. 43 patients had been diagnosed with parathyroid hyperplasia, and 4 patients had a benign adenoma. After operation, pruritus, bone pain and muscle weakness disappeared, also serum PTH and serum phosphate were declined markedly as well. After discharge, two patients (in total parathyroidectomy group) were readmitted because of postoperative hypoparathyroidism. Graft-dependent recurrence was not observed in an average follow-up of 42 months. Conclusions Total parathyroidectomy with sternocleidomastoid muscle trace amounts of parathyroid tissue autotransplantation is considered to be a feasible, safe and effective surgical option for the patients with sHPT.
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Affiliation(s)
- Qingqing He
- Department of Thyroid and Breast Surgery, Jinan Military General Hospital of PLA, No,25 Shifan Road, Jinan 250031, People's Republic of China.
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Impact of prophylactic central compartment neck dissection on locoregional recurrence of differentiated thyroid cancer in clinically node-negative patients: a retrospective study of a large clinical series. Surgery 2014; 155:998-1005. [PMID: 24856120 DOI: 10.1016/j.surg.2014.02.010] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 02/14/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND In clinically node-negative patients with differentiated thyroid cancer (DTC), indications for routine central lymph node dissection (RCLD) are the subject of intensive research, and surgeons are divided between the pros and cons of this surgery. To better define the role of neck dissection in the treatment of DTC, we analyzed retrospectively the results in three centers in Italy. METHODS The clinical records of 752 clinically node-negative patients with DTC who underwent operative treatment between January 1998 and December 2005 in three endocrine surgery referral units were evaluated retrospectively. The complications and medium- and long-term outcomes of total thyroidectomy (TT) alone (performed in 390 patients: group A) and TT combined with bilateral RCLD (362 patients: group B) were analyzed and compared. RESULTS The incidence of permanent hypoparathyroidism and permanent unilateral vocal folds was 1% and 0.8% in group A and 3.6% and 1.7% in the group B, respectively. Bilateral temporary recurrent nerve palsy was observed in one of the 362 patients in group B. After a follow-up of 9.5 ± 3.5 years (mean ± SD), the locoregional recurrence rate with positive cervical lymph nodes was not substantially significantly different between the two groups. CONCLUSION In our series, TT combined with bilateral RCLD was associated with a greater rate of transient and permanent complications. Similar incidences of locoregional recurrence were reported in the two groups of patients. Considering the recent trend toward routine central lymphadenectomy, further studies are needed to evaluate the benefits of these different approaches.
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Duan SY, Xing CY, Yang G, Wang NN, Zhang B. Dramatic alteration of the skull in a uremic patient with leontiasis ossea. Intern Med 2014; 53:1971-6. [PMID: 25175132 DOI: 10.2169/internalmedicine.53.2217] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The craniofacial skeleton represents a peculiar target of hyperparathyroidism in patients with end-stage renal disease who exhibit a dramatic pattern of uremic leontiasis ossea. Scant information regarding this condition is available in the renal literature, as the extreme and typical manifestations of leontiasis ossea have been described in only a small series of patients. We herein report a case of significant amelioration of massive modification of the facial appearance of a 30-year-old uremic Chinese woman with severe skeletal deformities who underwent total parathyroidectomy with a forearm autograft concurrently with effective drug treatment. This report may shed light on how to better understand and treat this metabolic derangement.
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Affiliation(s)
- Su-Yan Duan
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, China
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