Parathyroidectomy Rarely Achieves KDIGO Targets
Just 6.7% of patients had target levels of calcium, phosphorus, and parathyroid hormone a year after surgery.
CHICAGO—Few patients undergoing parathyroidectomy (PTx) attain targets for mineral and bone metabolism (CKD-MBD), according to findings presented at the American Society of Nephrology's 2016 Kidney Week meeting.
In a retrospective review of 79 hemodialysis patients (average age 45.8 years) who underwent PTx following refractory secondary hyperparathyroidism, 50.9%, 37.3%, and 9.1% had reached target levels of phosphorus, total calcium, and intact parathyroid hormone (iPTH) at 6 months. After 12 months, those proportions increased to 61.7%, 50%, and 22.6%, respectively, but they were still less than expected. No patient reached desired levels of all 3 markers at 6 months, and just 6.7% did so at 12 months. After a year, barely two-thirds (64.5%) of patients had iPTH levels below 150 pg/mL. The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines 2009 suggest target levels of iPTH in the range of 2 to 9 times the upper normal limit for the assay.
“PTx is useful in the control of calcium and phosphorus, however keeps the level of iPTH off target level,” concluded Adriana Belo Lopes Prazeres, MD, of Hospital das Clinicas de Pernambuco in Brazil, and colleagues. After PTx, there is usually a high occurrence of hypoparathyroidism. The most common surgery in this study was total PTx with autotransplantation.
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- Lopes Prazeres AB, Marcos Veiga T, de Assis Marinho Neto A, et al. Parathyroidectomy Achieves KDIGO Targets for Mineral and Bone Metabolism on Hemodialysis Patients? Presented at: Kidney Week 2016. November 15-20, 2016. Chicago. Abstract SA-PO963.