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Nephrology Dialysis Transplantation 2004 19(9):2417; doi:10.1093/ndt/gfh378
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Nephrol Dial Transplant Vol. 19 No. 9 © ERA-EDTA 2004; all rights reserved

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Sir,

We appreciate the comments made on our paper [1] by Cohen. A recent paper, indeed, showed a decline independent of age, gender and primary cause of end-stage renal disease (ESRD) of parathyroidectomy (PTx) rates since 1995 in a large population of patients with ESRD in the USA studied in the period of 1990–1999 [2]. As stated in that article, it is currently impossible to say whether the decline is due to improved control of serum parathyroid hormone by medical and dietary intervention, increased awareness of hyperparathyroidism, changes in referral patterns for PTx or a combination of all these. These recent data contrast with those provided by Malberti et al., which represent the largest database on PTx available in Europe. They studied a population of more than 14 000 ESRD patients in the period of 1983–1996 and saw no appreciable decline in the rate of PTx [3]. Unfortunately, there are no data available after the period of 1996 at the moment. We agree with Cohen that changes in PTx rates might be seen only over a long period of time in large populations [4]. In the meantime we must conclude that PTx is still needed in a significant number of patients and that this reflects our failure to adequately control disturbances in calcium, phosphate and vitamin D metabolism in patients with renal failure.

Conflict of interest statement. None declared.

Francisca Jorna

Department of Surgical Oncology University Hospital Groningen Groningen, the Netherlands Email: f.h.jorna{at}chir.azg.nl

References

  1. Jorna FH, Tobe TJ, 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]
  2. 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]
  3. 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]
  4. Cohen EP, Moulder JE. Parathyroidectomy in chronic renal failure: has medical care reduced the need for surgery? Nephron 2001; 89: 271–273[CrossRef][Medline]

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This Article
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