Introduction:
Secondary hyperparathyroidism (HPT) is a complex mineral and bone disorder that is common in patients with chronic kidney disease (CKD). Symptoms often include bone pain, pruritus and pathological fractures. Other complications such as vascular calcifications and calciphylaxis can threaten the patient's prognosis. Parathyroidectomy (PTX) is considered the best treatment option for patients who have failed medical therapy or those with advanced HPT. The dilemma lies between total resection methods, which carry the risk of permanent hypoparathyroidism and the conservative subtotal methods, less aggressive but exposing to the risk of persistent or recurrent HPT. While most studies conclude the safety of subtotal PTX, to our knowledge, none have provided clear guidance on management.
Methods:
We reviewed the data from 184 dialysis patients who underwent PTX between January 2015 and January 2023. We aimed to evaluate the short and long term outcomes of PTX in dialysis patients, comparing the conservative 3/4 versus 7/8 techniques in this population.
Results:
166 dialysis patients with secondary HPT were included. A conservative subtotal PTX (sPTX) 7/8 was performed in 72% of patients and sPTX 3/4 in 28% of them. Severe postoperative hypocalcemia related to a hungry bone syndrome ocurred in 45 patients (27%). Hypocalcaemia was significantly more frequent in the sPTX 7/8 group (p=0.012). During the long-term follow-up, one case of persistent HPT (0.6%) and 20 cases of recurrence (12%) were diagnosed. Recurrence was more frequent in the sPTX 3/4 group (15%) compared to the 7/8 group (11%), but it was not statistically associated with the type of surgery. No deaths were reported during the perioperative period.
Conclusions:
Secondary hyperparathyroidism (HPT) is an early and common mineral and bone disorder in dialysis patients. Its therapeutic management is complex. In cases of advanced or tertiary HPT, PTX should be recommended. sPTX is an effective surgery with relatively few surgical complications and a low rate of perioperative mortality. Its complications may include persistence/recurrence of HPT if the resected parathyroid volume is insufficient, or definitive hypoparathyroidism if the resection is too aggressive. sPTX 3/4 method seems to be a reasonable surgical method. However, more studies are needed to determine the type of surgery required for each patient.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.