NDT Advance Access originally published online on February 15, 2008
Nephrology Dialysis Transplantation 2008 23(7):2319-2323; doi:10.1093/ndt/gfm931
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Parathyroidectomy as a therapeutic tool for targeting the recommended NKF-K/DOQITM ranges for serum calcium, phosphate and parathyroid hormone in dialysis patients
1 Departments of Clinical Science 2 Experimental Medicine 3 Surgical Science, ‘Sapienza’ University of Rome, Italy
Correspondence and offprint requests to: Sandro Mazzaferro, Department of Clinical Science, Nephrology, ‘Sapienza’ University, Viale del Policlinico 155; 00161 Roma, Italy. Tel: +39-06-49972666; Fax: +39-06-49970524; E-mail: sandro.mazzaferro{at}uniroma1.it
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Abstract |
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Background. The recommended NKF-K/DOQI’99 ranges for Ca, P and PTH in dialysis seem advisable also for patients previously submitted to parathyroidectomy; however no paper addresses, specifically in this condition, to what extent optimal values are targeted in the short and long term after surgery.
Methods. We checked serum Ca, P and PTH basally and after 1 month and 1, 3 and 5 years since surgery, in 77 dialysis subjects who received parathyroidectomy in our hospital.
Results. Immediately after surgery all biochemical para- meters dropped, but afterwards Ca showed a tendency to increase progressively in the long term (p <.0006), P increased mostly within one year (p <.01), and PTH increased similarly to Ca (p <.003), but with mean values always in the lower than desired range. The estimated percentage of patients at target during the follow-up was maximal for P (values between 65 and 76%), lower for Ca (zenith of 43% after 1 month but declining down to 14% after 5 years) and minimal for PTH (invariably <10%). Persistence within the ranges (at least on two consecutive checks) was 21% after one month for Ca, with a tendency to reduction; 41% for P, with a tendency to average roughly 30%, and practically zero for PTH. Neither type of surgery (total or subtotal) nor vitamin D therapy were associated with the low values of PTH observed.
Conclusions. We conclude that parathyroid surgery does not represent an optimal therapeutic tool for targeting the recommended ranges for Ca, P and PTH. In particular, too low PTH values are frequently obtained, whose clinical effects deserve further studies. The possibility of a time dependent risk for recurrence is confirmed.
Keywords: NKF-K/DOQI guidelines; parathyroid hormone; parathytroidectomy; secondary hyperparathyroidism
Received for publication: 4. 9.07
Accepted in revised form: 17.12.07