Kidney Disease Improving Global Outcomes guidelines and parathyroidectomy for renal hyperparathyroidism

Sarah C. Oltmann, Tariq M. Madkhali, Rebecca S. Sippel, Herbert Chen, David F. Schneider

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background Patients with end-stage renal disease develop hypocalcemia, resulting in secondary hyperparathyroidism (SHPT). No clear criterions exist to aid in surgical decision making for SHPT. The 2009 Kidney Disease Improving Global Outcomes (KDIGO) guidelines provide target ranges for serum calcium, phosphate, and parathyroid hormone (PTH) levels in patients with end-stage renal disease. Parathyroidectomy can help achieve these targets. The study purpose was to examine how parathyroidectomy for SHPT impacts KDIGO targets during immediate and long-term follow-up and to evaluate KDIGO categorization with receipt of additional surgical intervention. Methods A retrospective review of a prospective parathyroidectomy database was performed. Included patients had SHPT, were on dialysis, and underwent parathyroidectomy. Calcium, phosphate, and PTH values were classified as below, within, or above KDIGO targets. Results Between 2000 and 2013, 36 patients with SHPT met criteria. Subtotal parathyroidectomy was performed in 89%, total parathyroidectomy in 11%. Follow-up time was 54 ± 7 mo. Eight patients (22%) required additional surgery. Twenty-eight patients (76%) were alive at the last follow-up. At the last-follow up, patients had phosphate (46%), and PTH (17%) above KDIGO ranges. Factors associated with reoperation were assessed. Patient PTH within or above target immediately postoperative had a higher rate of reoperation (P <0.01). At the last follow-up, higher phosphate (P = 0.054) and PTH (P <0.001) were associated with higher reoperation rates, but calcium (P = 0.33) was not. Conclusions PTH and phosphate levels above KDIGO indices were associated with additional surgical intervention. Many patients had laboratory indices above range at the last follow up, suggesting more patients had persistent or recurrent disease than those who underwent reoperation. Patients may benefit from more aggressive medical and/or surgical management.

Original languageEnglish (US)
Pages (from-to)115-120
Number of pages6
JournalJournal of Surgical Research
Volume199
Issue number1
DOIs
StatePublished - Nov 1 2015

Fingerprint

Parathyroidectomy
Hyperparathyroidism
Kidney Diseases
Guidelines
Kidney
Secondary Hyperparathyroidism
Parathyroid Hormone
Reoperation
Phosphates
Chronic Kidney Failure
Hypocalcemia
Dialysis
Decision Making
Databases

Keywords

  • KDIGO
  • Mineral and bone disorder
  • Parathyroidectomy
  • Renal hyperparathyroidism
  • Secondary hyperparathyroidism

ASJC Scopus subject areas

  • Surgery

Cite this

Kidney Disease Improving Global Outcomes guidelines and parathyroidectomy for renal hyperparathyroidism. / Oltmann, Sarah C.; Madkhali, Tariq M.; Sippel, Rebecca S.; Chen, Herbert; Schneider, David F.

In: Journal of Surgical Research, Vol. 199, No. 1, 01.11.2015, p. 115-120.

Research output: Contribution to journalArticle

Oltmann, Sarah C. ; Madkhali, Tariq M. ; Sippel, Rebecca S. ; Chen, Herbert ; Schneider, David F. / Kidney Disease Improving Global Outcomes guidelines and parathyroidectomy for renal hyperparathyroidism. In: Journal of Surgical Research. 2015 ; Vol. 199, No. 1. pp. 115-120.
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abstract = "Background Patients with end-stage renal disease develop hypocalcemia, resulting in secondary hyperparathyroidism (SHPT). No clear criterions exist to aid in surgical decision making for SHPT. The 2009 Kidney Disease Improving Global Outcomes (KDIGO) guidelines provide target ranges for serum calcium, phosphate, and parathyroid hormone (PTH) levels in patients with end-stage renal disease. Parathyroidectomy can help achieve these targets. The study purpose was to examine how parathyroidectomy for SHPT impacts KDIGO targets during immediate and long-term follow-up and to evaluate KDIGO categorization with receipt of additional surgical intervention. Methods A retrospective review of a prospective parathyroidectomy database was performed. Included patients had SHPT, were on dialysis, and underwent parathyroidectomy. Calcium, phosphate, and PTH values were classified as below, within, or above KDIGO targets. Results Between 2000 and 2013, 36 patients with SHPT met criteria. Subtotal parathyroidectomy was performed in 89{\%}, total parathyroidectomy in 11{\%}. Follow-up time was 54 ± 7 mo. Eight patients (22{\%}) required additional surgery. Twenty-eight patients (76{\%}) were alive at the last follow-up. At the last-follow up, patients had phosphate (46{\%}), and PTH (17{\%}) above KDIGO ranges. Factors associated with reoperation were assessed. Patient PTH within or above target immediately postoperative had a higher rate of reoperation (P <0.01). At the last follow-up, higher phosphate (P = 0.054) and PTH (P <0.001) were associated with higher reoperation rates, but calcium (P = 0.33) was not. Conclusions PTH and phosphate levels above KDIGO indices were associated with additional surgical intervention. Many patients had laboratory indices above range at the last follow up, suggesting more patients had persistent or recurrent disease than those who underwent reoperation. Patients may benefit from more aggressive medical and/or surgical management.",
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AB - Background Patients with end-stage renal disease develop hypocalcemia, resulting in secondary hyperparathyroidism (SHPT). No clear criterions exist to aid in surgical decision making for SHPT. The 2009 Kidney Disease Improving Global Outcomes (KDIGO) guidelines provide target ranges for serum calcium, phosphate, and parathyroid hormone (PTH) levels in patients with end-stage renal disease. Parathyroidectomy can help achieve these targets. The study purpose was to examine how parathyroidectomy for SHPT impacts KDIGO targets during immediate and long-term follow-up and to evaluate KDIGO categorization with receipt of additional surgical intervention. Methods A retrospective review of a prospective parathyroidectomy database was performed. Included patients had SHPT, were on dialysis, and underwent parathyroidectomy. Calcium, phosphate, and PTH values were classified as below, within, or above KDIGO targets. Results Between 2000 and 2013, 36 patients with SHPT met criteria. Subtotal parathyroidectomy was performed in 89%, total parathyroidectomy in 11%. Follow-up time was 54 ± 7 mo. Eight patients (22%) required additional surgery. Twenty-eight patients (76%) were alive at the last follow-up. At the last-follow up, patients had phosphate (46%), and PTH (17%) above KDIGO ranges. Factors associated with reoperation were assessed. Patient PTH within or above target immediately postoperative had a higher rate of reoperation (P <0.01). At the last follow-up, higher phosphate (P = 0.054) and PTH (P <0.001) were associated with higher reoperation rates, but calcium (P = 0.33) was not. Conclusions PTH and phosphate levels above KDIGO indices were associated with additional surgical intervention. Many patients had laboratory indices above range at the last follow up, suggesting more patients had persistent or recurrent disease than those who underwent reoperation. Patients may benefit from more aggressive medical and/or surgical management.

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