Laboratory criteria for the persistence of secondary hyperparathyroidism in patients with chronic kidney disease

M. Urina, V. Palamarchuk, O. Tovkai, V. Kuts, T. Yuzvenko

DOI: http://dx.doi.org/10.12775/JEHS.2020.10.11.007

Abstract


Secondary hyperparathyroidism is a complication of chronic kidney disease in both the non-dialysis and dialysis stages. Even modern advances in drug therapy cannot change the fact that most CKD patients require surgical treatment. The purpose of the treatment of SHPT is to normalize mineral metabolism, prevent bone diseases and prevent extraosseous manifestations. One of the methods of surgical treatment is subtotal parathyroidectomy. Persistence or recurrence of the disease occurs in 5-30% of cases.

Purpose of the study. To determine laboratory criteria for the persistence of SHPT in patients with chronic kidney disease on the second day after parathyroidectomy.

Materials and methods. The study involved 118 patients with end-stage CKD with prolonged renal replacement therapy. All patients had clinical and laboratory signs of secondary hyperparathyroidism. In the period from 2009 to 2019, patients underwent subtotal parathyroidectomy. The patients were divided into two groups. This division was based on the presence of persistence or recurrence of the disease. The main group included 20 patients with laboratory signs of SHPT persistence; the comparison group included 98 patients without signs of disease’s persistence.

Results. Analysis of changes in laboratory parameters in patients with persistence and in patients without signs of disease’s persistence revealed certain differences in their postoperative level. In all 118 cases, there was a significant decrease in PTH in the postoperative period - from 31.5 to 99.6%. Using ROC-analysis, a study was carried out of the possibility of using the degree of PTH reduction as a predictor of the persistent course of SHPT and the optimal cut-off thresholds were established. A decrease in the postoperative level of PTH by 90.9% or more indicates an effective PTE. The maximum value of the test specificity (1.000 (0.968; 1.000)) is achieved when the PTH reduction is 76.0%. At the same time, the maximum value - 1.000 (0.968; 1.000) - reaches the predictive value of a positive test result.

Conclusions. Using the subtotal parathyroidectomy in our study, the persistent of SHPT occurred in 16.9% of cases. A decrease in PTH levels on the second day after surgery less than 76% comparatively to the preoperative level should be considered as a predictor of the development of disease persistence. A reduction in PTH of more than 90.9% may be an indication of sustained remission.


Keywords


Parathyroid gland; parathyroid hormone; secondary hyperparathyroidism; chronic kidney disease; persistence of secondary hyperparathyroidism.

Full Text:

PDF

References


Quarles LD, Berkoben M. Management of secondary hyperparathyroidism in dialysis patients. In: UpToDate. Available from: https://www.uptodate.com/contents/management-of-secondary-hyperparathyroidism-in-dialysis-patients (accessed on Mar 5, 2018).

Quarles LD, Berkoben M. Management of secondary hyperparathyroidism in adult nondialysis patients with chronic kidney disease. In: UpToDate. Available from: https://www.uptodate.com/contents/management-of-secondary-hy-yperparathyroidism-in-adult-nondialysis-patients-with-chronic-kidney-disease (accessed on Mar 5, 2018)

Ketteler M, Block GA, Evenepoel P, et al. Executive summary of the 2017 KDIGO Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) Guideline Update: what's changed and why it matters. Kidney Int 2017; 92:26.

Springer International Publishing Switzerland 2017 B.C. Stack, Jr., D.L. Bodenner (eds.), Medical and Surgical Treatment of Parathyroid Diseases. DOI 10.1007/978-3-319-26794-4_1

Sarah Tomasello. Secondary Hyperparathyroidism and Chronic Kidney Disease. Diabetes Spectrum 2008 Jan; 21(1): 19-25. DOI:10.2337/diaspect.21.1.19

Parathyroidectomy in the Management of Secondary Hyperparathyroidism: Clin J Am Soc Nephrol. 2018 Jun 7; 13(6): 952–961. DOI: 10.2215/CJN.10390917.

Mier MV, Rodríguez M. Parathyroidectomy in dialysis patients: Indications, methods, and consequences. Semin Dial. 2019; 32:444–451. DOI:10.1111/sdi.12772

Mira Milas: Parathyroidectomy in end-stage kidney disease. In UpToDate, edited by Carty SE, Chen W, Waltham, MA, UpToDate Inc. Accessed October 25,2017

Monique Nakayama Ohe, Rodrigo Oliveira Santos and co. Intraoperative PTH cut-off definition to predict successful parathyroidectomy in secondary and tertiary hyperparathyroidism. DOI: 10.5935/1808-8694.20130088

Jun Yang Persistent secondary hyperparathyroidism caused by parathyromatosis and supernumerary parathyroid glands in a patient on haemodialysis BMC Nephrology volume 21, Article number: 257 (2020). DOI:10.1186/s12882-020-01917-3

Schneider R, Waldmann J, Ramaswamy A, Fernandez ED, Bartsch DK, Schlosser K. Frequency of ectopic and supernumerary intrathymic parathyroid glands in patients with renal hyperparathyroidism: analysis of 461 patients undergoing initial parathyroidectomy with bilateral cervical thymectomy. World J Surg. 2011;35:1260–5. DOI: 10.1007/s00268-011-1079-6.

Mario Cozzolino and co. Treatment of secondary hyperparathyroidism: the clinical utility of etelcalcetide. Ther Clin Risk Manag. 2017; 13: 679–689. DOI: 10.2147/TCRM.S108490

Gasparri, G., Palestini, N., Freddi, M., Sisto, G., & Camandona, M. (2016). Parathyroid Exploration for Primary Hyperparathyroidism. Primary, Secondary and Tertiary Hyperparathyroidism, 117–132. DOI:10.1007/978-88-470-5758-6_1

Modern Parathyroid Surgery and Intra-Operative Hormone Monitoring; Present Status, Future Concepts DOI: 10.4172/2157-7536.1000190

Monique Nakayama Ohe, Rodrigo Oliveira Santos and co. Intraoperative PTH cutoff definition to predict successful parathyroidectomy in secondary and tertiary hyperparathyroidism. DOI: 10.5935/1808-8694.20130088

Subtotal parathyroidectomy for secondary renal hyperparathyroidism: a 20-year surgical outcome study Langenbecks Arch Surg. 2016; 401(7): 965–974.

DOI:10.1007/s00423-016-1447-7

Melih Kara Evaluation of Intraoperative Parathormone Measurement for Predicting Successful Surgery in Patients Undergoing Subtotal/ Total Parathyroidectomy Due to Secondary Hyperparathyroidism The Laryngoscope 120(8):1538-44, August 2010. DOI: 10.1002/lary.21023

The Value of Intraoperative Parathyroid Hormone Monitoring in Localized Primary Hyperparathyroidism: A Cost Analysis Lilah F. Morris Ann Surg Oncol. 2010 Mar; 17(3): 679–685. DOI:10.1245/s10434-009-0773-1

Shawky et al., J Steroids Horm Sci 2018, 9:1 Modern Parathyroid Surgery and Intra-Operative Hormone Monitoring; Present Status, Future Concepts Journal of Steroids & Hormonal Science DOI: 10.4172/2157-7536.1000190

National Kidney Foundation. K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis 2003;42(4 Suppl 3):S1-201.

Dotzenrath C, Cupisti K, Goretzki E, Mondry A, Vossough A, Grabensee B, et al. Operative treatment of renal autonomous hyperparathyroidism: cause of persistent or recurrent disease in 304 patients. Langenbecks Arch Surg 2003;387:348-54.

DOI: 10.1590/S0102-86502007000200005

Gomes EMS, Nunes RC, Lacativa PGS, Almeida MH, Franco FM, Leal CTS, Patrício Filho PJM, Farias MLF, Gonçalves Ectopic and extranumerary parathyroid glands location in patients with hyperparathyroidism secondary to end stage renal disease. Acta Cir Bras. 2007 Mar-Apr;22(2). DOI:10.1590/S0102-86502007000200005

James W Moor 1, Steven Roberts : Intraoperative parathyroid hormone monitoring to determine long-term success of total parathyroidectomy for secondary hyperparathyroidism. Head Neck 2011 Mar;33(3):293-6. DOI: 10.1002/hed.21441

Monique Nakayama Ohe, Rodrigo Oliveira Santos: Intraoperative PTH cutoff definition to predict successful parathyroidectomy in secondary and tertiary hyperparathyroidism. Braz J Otorhinolaryngol, 2013 Aug; 79(4):494-9. DOI: 10.5935/1808-8694.20130088.

Urina M., Palamarchuk V.: Study of the correlation between the size of the parathyroid adenoma and the level of parathyroid hormone, calcium, phosphorus and vitamin D in the serum of patients with primary hyperparathyroidism. Clinical endocrinology and endocrine surgery, №2(2019). DOI: http://doi.org/10.30978/CEES-2019-2-30


Article Metrics

Metrics Loading ...

Metrics powered by PLOS ALM




Journal of Education, Health and Sport formerly Journal of Health Sciences

Declaration on the original version.

Editors indicates that the main version of the magazine is to issue a "electronic".

The journal has had 5 points in Ministry of Science and Higher Education parametric evaluation. § 8. 2) and § 12. 1. 2) 22.02.2019.

1223 Journal of Education, Health and Sport eISSN 2391-8306 7

ISSN 2391-8306 formerly ISSN: 1429-9623 / 2300-665X

Archives 2011 - 2014

PBN 2011 - 2014

https://pbn.nauka.gov.pl/sedno-webapp/search?search&searchCategory=WORK&filter.inJournal=36616

POL-index 2011 - 2014

https://pbn.nauka.gov.pl/polindex-webapp/browse/journal/journal-32a319c5-a850-4f44-ba70-1418a6087655

BASE 2011 - 2014

https://www.base-search.net/Search/Results?lookfor=Journal+of+Health+Sciences+%28Radom%29&type=all&oaboost=1&ling=1&name=&thes=&refid=dcrespl&newsearch=1

http://elibrary.ru/contents.asp?titleid=37467

http://journal.rsw.edu.pl/index.php/JHS/issue/archive

Indexed in Bases, Bazy indeksacyjne: ERIH Plus, Worldcat, PBN/POL-Index, ICI Journals Master List, Directory of Open Access Journals (DOAJ), ZBD, Ulrich's periodicals, Google Scholar, Polska Bibliografia Lekarska, EuroPub database, NLM Catalog Result - NCBI, BASE, Russian Sciences Index, Arianta.

https://zdb-katalog.de/title.xhtml?idn=1080187162

https://europub.co.uk/journals/22625

US NLM = 101679844

101679844 - NLM Catalog Result - NCBI

https://www.ncbi.nlm.nih.gov/nlmcatalog/101679844

Find a library that holds this journal: http://worldcat.org/issn/23918306

 

PBN Poland

https://pbn.nauka.gov.pl/sedno-webapp/journals/49068

POL-index

https://pbn.nauka.gov.pl/polindex-webapp/browse/journal/journal-c39c8169-88d2-45db-9e7f-d948ce9981c4

BASE

https://www.base-search.net/Search/Results?join=AND&bool0[]=AND&lookfor0[]=2391-8306&type0[]=all&page=11&l=pl&oaboost=1&refid=dcpagepl

Redaction, Publisher and Editorial Office

Publisher and Editorial Office
Department of Physical Culture,
Faculty of Earth Sciences and Spatial Management,
Nicolaus Copernicus University in Toruń, Poland
Address: Str. Lwowska 1, 87-100 Toruń, Poland

  Open Access ISSN 2391-8306 formerly ISSN: 1429-9623 / 2300-665X

The journal has been approved for inclusion in ERIH PLUS.

The ERIH PLUS listing of the journal is available at https://dbh.nsd.uib.no/publiseringskanaler/erihplus/periodical/info?id=485984

Indexed in Index Copernicus Journals Master List.

http://journals.indexcopernicus.com/Journal+of+Education+Health+and+Sport,p24782242,3.html

ICV 2019 = 100.00 ICV 2018 = 95.95 ICV 2017 = 91.30 ICV 2016 = 84.69 ICV 2015 = 93.34 ICV 2014 = 89.51 Standardized Value: 8.27 ICV 2013: 7.32 ICV 2012: 6.41 ICV 20115.48

RG Journal Impact: 0.18 *

*This value is calculated using ResearchGate data and is based on average citation counts from work published in this journal. The data used in the calculation may not be exhaustive.

RG Journal impact history

2020Available summer 2021
2018 / 20190.18
20170.07
20160.03

RG Journal impact over time

RG Journal impact
0.180.160.140.120.100.080.060.040.02201620172018
  

Indexed in Polish Scholarly Bibliography (PBN) (PBN Polska Bibliografia Naukowa) (https://pbn.nauka.gov.pl/journals/36616)

is a portal of the Polish Ministry of Science and Higher Education, collecting information on publications of Polish scientists and on Polish and foreign scholarly journals. Polish Scholarly Bibliograhpy is a part of POL-on - System of Information on Higher Education. It is operated by the Interdisciplinary Centre for Mathematical and Computational Modelling, University of Warsaw.

Indexed in Russian Sciences Index Российский индекс научного цитирования (РИНЦ) http://elibrary.ru/contents.asp?titleid=37467

Indexed in Arianta Polish scientific and professional electronic journals Aneta Drabek i Arkadiusz Pulikowski

(http://www1.bg.us.edu.pl/bazy/czasopisma/czasop_full.asp?id=3595)

Partnerzy platformy czasopism