Nephrol Dial Transplant Vol. 19 No. 9 © ERA-EDTA 2004; all rights reserved
The need for parathyroidectomy
Sir,It is impressive to know that a serum phosphate level of >1.85 mmol/l (5.7 mg/dl) at 1 year after the start of dialysis may predict future need for parathyroidectomy [1]. Jorna et al. [1] also claim that the use of parathyroidectomy has not changed in recent years, perhaps trying to suggest that our management of secondary hyperparathyroidism remains inadequate. But data from the United States Renal Data System, spanning the decade from 1988 to 1998, clearly show that use of parathyroidectomy has declined significantly over this time [2]. A follow-up analysis of USRDS data has confirmed this [3]. The USRDS data are in contrast to the smaller negative dataset of Malberti et al. [4]. Significant trends with time could be missed unless one uses a large enough population. Thus, the US data are probably more reliable.
More importantly, there may be survival benefit to a properly timed parathyroidectomy [5]. Thus, medical management of secondary hyperparathyroidism in chronic dialysis patients has probably improved in recent years. This correlates well with increasing use of vitamin D analogues. The new calcimimetic agents might add to this benefit, but we are already doing better than we did in the bad old days.
Conflict of interest statement. None declared.
Department of Medicine Medical College of Wisconsin Milwaukee, WI USA Email: ecohen{at}mcw.edu
References
- Jorna FH, Tobé TJM, Huisman RM et al. Early identification of risk factors for refractory secondary hyperparathyroidism in patients with long term renal replacement therapy. Nephrol Dial Transplant 2004; 19: 1168–1173
[Abstract/Free Full Text] - Cohen EP, Moulder JE. Parathyroidectomy in chronic renal failure: has medical care reduced the need for surgery? Nephron 2001; 89: 271–273[CrossRef][Medline]
- Kestenbaum B, Seliger SL, Gillen DL et al. Parathyroidectomy rates among United States dialysis patients: 1990–1999. Kidney Int 2004; 65: 282–288[CrossRef][Medline]
- Malberti F, Marcelli D, Conte F et al. Parathyroidectomy in patients on renal replacement therapy: an epidemiologic study. J Am Soc Nephrol 2001; 12: 1242–1248
[Abstract/Free Full Text] - Trombetti A, Herrman F, Stoermann C et al. Parathyroidectomy in patients with end stage renal disease and severe secondary hyperparathyroidism is associated with a six fold increased survival. J Am Soc Nephrol 2003; 14: 683a
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||