Targeted surgical parathyroidectomy in end-stage renal disease patients and long-term metabolic control: A single-center experience in the current era

Tibor Fülöp; Christian A Koch; Abdeen R Farah Musa; Christopher M Clark; Kamel A Gharaibeh; Zsolt Lengvársky; Mehrdad Hamrahian; Karen T Pitman; Mehul P Dixit

doi:10.1111/hdi.12639

Targeted surgical parathyroidectomy in end-stage renal disease patients and long-term metabolic control: A single-center experience in the current era

Hemodial Int. 2018 Jul;22(3):394-404. doi: 10.1111/hdi.12639. Epub 2018 Feb 15.

Authors

Affiliations

¹ Division of Nephrology, Diabetes and Metabolism, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA.
² Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA.
³ G.V. (Sonny) Montgomery VA Medical Center, Jackson, Mississippi, USA.
⁴ Cancer Institute, University of Mississippi Medical Center, Jackson, Mississippi, USA.
⁵ Department of Otolaryngology - Head and Neck Surgery, University of Texas Southwestern, Dallas, Texas, USA.
⁶ Department of Mathematics, Louisiana State University Shreveport, Shreveport, Louisiana, USA.
⁷ Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
⁸ Johns Hopkins Department of Otolaryngology, Milton J. Dance Jr. Head and Neck Center, Baltimore, Maryland, USA.
⁹ Division of Pediatric Nephrology, Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi, USA.

PMID: 29446565
DOI: 10.1111/hdi.12639

Abstract

Background: The long-term results of surgical parathyroidectomy (PTX) in end-stage renal disease (ESRD) patients are less well known in the modern era of newer activated vitamin-D analogs, calcimimetics and intraoperative monitoring of parathyroid hormone (PTH).

Methods: We performed a retrospective chart review of all ESRD patients undergoing PTX at the University of Mississippi Medical Center between January 2005 and August 2011, with follow-up data as available up to 4 years. All PTXs were performed with intraoperative second-generation PTH monitoring and targeted gland size reduction.

Results: The cohort (N = 37) was relatively young with a mean (±SD) age of 48.4 ± 13.9. 94.6% of the subjects were African American and 59.5% female. Preoperatively, 45.9% received cinacalcet (CNC) at a mean dose of 63.5 ± 20.9 mg. The size of the largest removed glands measured 1.7 ± 0.8 cm and almost all (94.6%) glands had hyperplasia on histology. The mean length of inpatient stay was 5.5 ± 2.4 days. Preoperative calcium/phosphorus measured 9.6 ± 1.2/6.6 ± 1.7 mg/dL with PTH concentrations of 1589 ± 827 pg/mL. Postoperative PTH values measured 145.4 ± 119.2 pg/mL. Preoperative PTH strongly correlated (P < 0.0001) with both alkaline phosphatase (ALP) levels (r: 0.596) and the number of inpatient days (r: 0.545), but not with CNC administration. Independent predictors for the duration of hospitalization were preoperative ALP (beta 0.469; P = 0.001) and age (beta -0.401; P = 0.005) (R² 0.45); for postoperative hypocalcemia, age (beta: -0.321; P = 0.006) and preoperative PTH (beta: 0.431; P = 0.036) were significant in linear regression models with stepwise selection.

Conclusion: Gland-sparing PTX achieved acceptable control of ESRD-associated hyperparathyroidism in most patients from a socioeconomically challenged, underserved population of the United States.

Keywords: Activated vitamin-D; African American; alkaline phosphatase; hungry bone syndrome; hypocalcemia; secondary hyperparathyroidism.

MeSH terms

Cohort Studies
Female
Humans
Kidney Failure, Chronic / pathology
Kidney Failure, Chronic / surgery*
Male
Middle Aged
Parathyroidectomy / methods*
Renal Dialysis / methods*
Retrospective Studies