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 Pitman, Mehul P. Dixit

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)394-404
Number of pages11
JournalHemodialysis International
Volume22
Issue number3
DOIs
StatePublished - Jul 1 2018

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Parathyroidectomy
Parathyroid Hormone
Chronic Kidney Failure
Alkaline Phosphatase
Inpatients
Linear Models
Intraoperative Monitoring
Mississippi
Hypocalcemia
Hyperparathyroidism
Vulnerable Populations
Vitamin D
African Americans
Phosphorus
Hyperplasia
Length of Stay
Histology
Hospitalization
Calcium

Keywords

  • Activated vitamin-D
  • African American
  • alkaline phosphatase
  • hungry bone syndrome
  • hypocalcemia
  • secondary hyperparathyroidism

ASJC Scopus subject areas

  • Hematology
  • Nephrology

Cite this

Targeted surgical parathyroidectomy in end-stage renal disease patients and long-term metabolic control : A single-center experience in the current era. / Fülöp, Tibor; Koch, Christian A.; Farah Musa, Abdeen R.; Clark, Christopher M.; Gharaibeh, Kamel A.; Lengvársky, Zsolt; Hamrahian, Mehrdad; Pitman, Karen; Dixit, Mehul P.

In: Hemodialysis International, Vol. 22, No. 3, 01.07.2018, p. 394-404.

Research output: Contribution to journalArticle

Fülöp, Tibor ; Koch, Christian A. ; Farah Musa, Abdeen R. ; Clark, Christopher M. ; Gharaibeh, Kamel A. ; Lengvársky, Zsolt ; Hamrahian, Mehrdad ; Pitman, Karen ; Dixit, Mehul P. / Targeted surgical parathyroidectomy in end-stage renal disease patients and long-term metabolic control : A single-center experience in the current era. In: Hemodialysis International. 2018 ; Vol. 22, No. 3. pp. 394-404.
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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.",
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AU - Farah Musa, Abdeen R.

AU - Clark, Christopher M.

AU - Gharaibeh, Kamel A.

AU - Lengvársky, Zsolt

AU - Hamrahian, Mehrdad

AU - Pitman, Karen

AU - Dixit, Mehul P.

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N2 - 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.

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