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Utilization of parathyroidectomy for secondary hyperparathyroidism in end-stage renal disease

BACKGROUND: The utilization of parathyroidectomy (PTX) to manage secondary hyperparathyroidism (SHPT) refractory to medical management (MTX) in end-stage renal disease (ESRD) in the era of calcimimetics is not well known. METHODS: Adult ESRD patients receiving dialysis between August 2007 and Decemb...

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Autores principales: Konstantinidis, Ioannis, Nadkarni, Girish, Divino, Celia M., Lapsia, Vijay
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4400475/
https://www.ncbi.nlm.nih.gov/pubmed/26064486
http://dx.doi.org/10.1093/ckj/sft028
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author Konstantinidis, Ioannis
Nadkarni, Girish
Divino, Celia M.
Lapsia, Vijay
author_facet Konstantinidis, Ioannis
Nadkarni, Girish
Divino, Celia M.
Lapsia, Vijay
author_sort Konstantinidis, Ioannis
collection PubMed
description BACKGROUND: The utilization of parathyroidectomy (PTX) to manage secondary hyperparathyroidism (SHPT) refractory to medical management (MTX) in end-stage renal disease (ESRD) in the era of calcimimetics is not well known. METHODS: Adult ESRD patients receiving dialysis between August 2007 and December 2011 at our institution with an intact parathyroid hormone (iPTH) level ≥88 pmol/L for 6 months associated with hypercalcemia and/or hyperphosphatemia for at least 50% of that period were included. Baseline characteristics and iPTH, calcium, phosphorus, calcium–phosphorus product and alkaline phosphatase (ALP) at baseline, 6 and 12 months were compared between the two groups (PTX versus MTX) using the χ(2) and paired t-tests. RESULTS: Of the total population of 687 patients, 80 (11.6%) satisfied KDOQI criteria for PTX, most of whom did not receive PTX (81.2%). At baseline, PTX patients had been on dialysis longer (P = 0.001), with higher iPTH (P < 0.001), calcium (P = 0.008) and ALP (P = 0.001) and were less likely to be African-American (P = 0.007). Complete follow-up data at 6 months were available on 75 patients (PTX = 15; MTX = 60). PTX had significantly greater reduction in iPTH (93 versus 23%) and ALP (68 versus 0%) compared with MTX. Changes from baseline in calcium, phosphate or calcium–phosphorus product levels and proportion of patients achieving KDOQI target values were not significant for either intervention. Findings were consistent at 12 months. CONCLUSIONS: A significant proportion of ESRD patients who met indications for PTX did not receive it. Additional studies are needed to understand the barriers that prevent patients from receiving PTX, thereby resulting in underutilization.
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spelling pubmed-44004752015-06-10 Utilization of parathyroidectomy for secondary hyperparathyroidism in end-stage renal disease Konstantinidis, Ioannis Nadkarni, Girish Divino, Celia M. Lapsia, Vijay Clin Kidney J Original Contributions BACKGROUND: The utilization of parathyroidectomy (PTX) to manage secondary hyperparathyroidism (SHPT) refractory to medical management (MTX) in end-stage renal disease (ESRD) in the era of calcimimetics is not well known. METHODS: Adult ESRD patients receiving dialysis between August 2007 and December 2011 at our institution with an intact parathyroid hormone (iPTH) level ≥88 pmol/L for 6 months associated with hypercalcemia and/or hyperphosphatemia for at least 50% of that period were included. Baseline characteristics and iPTH, calcium, phosphorus, calcium–phosphorus product and alkaline phosphatase (ALP) at baseline, 6 and 12 months were compared between the two groups (PTX versus MTX) using the χ(2) and paired t-tests. RESULTS: Of the total population of 687 patients, 80 (11.6%) satisfied KDOQI criteria for PTX, most of whom did not receive PTX (81.2%). At baseline, PTX patients had been on dialysis longer (P = 0.001), with higher iPTH (P < 0.001), calcium (P = 0.008) and ALP (P = 0.001) and were less likely to be African-American (P = 0.007). Complete follow-up data at 6 months were available on 75 patients (PTX = 15; MTX = 60). PTX had significantly greater reduction in iPTH (93 versus 23%) and ALP (68 versus 0%) compared with MTX. Changes from baseline in calcium, phosphate or calcium–phosphorus product levels and proportion of patients achieving KDOQI target values were not significant for either intervention. Findings were consistent at 12 months. CONCLUSIONS: A significant proportion of ESRD patients who met indications for PTX did not receive it. Additional studies are needed to understand the barriers that prevent patients from receiving PTX, thereby resulting in underutilization. Oxford University Press 2013-06 2013-03-28 /pmc/articles/PMC4400475/ /pubmed/26064486 http://dx.doi.org/10.1093/ckj/sft028 Text en © The Author 2013. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For permissions, please email: journals.permissions@oup.com http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Original Contributions
Konstantinidis, Ioannis
Nadkarni, Girish
Divino, Celia M.
Lapsia, Vijay
Utilization of parathyroidectomy for secondary hyperparathyroidism in end-stage renal disease
title Utilization of parathyroidectomy for secondary hyperparathyroidism in end-stage renal disease
title_full Utilization of parathyroidectomy for secondary hyperparathyroidism in end-stage renal disease
title_fullStr Utilization of parathyroidectomy for secondary hyperparathyroidism in end-stage renal disease
title_full_unstemmed Utilization of parathyroidectomy for secondary hyperparathyroidism in end-stage renal disease
title_short Utilization of parathyroidectomy for secondary hyperparathyroidism in end-stage renal disease
title_sort utilization of parathyroidectomy for secondary hyperparathyroidism in end-stage renal disease
topic Original Contributions
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4400475/
https://www.ncbi.nlm.nih.gov/pubmed/26064486
http://dx.doi.org/10.1093/ckj/sft028
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