A comparative analysis of three types of parathyroidectomies in renal hyperparathyroidism. Single centre prospective cohort of 77 patients

Abstract

BACKGROUND: There is no consensus regarding optimal timing or best surgical procedure for refractory renal hyperparathyroidism patients. We aim to compare the results after three types of parathyroidectomies performed for sHPT in a single referral centre.

METHODS: This study included patients on chronic hemodialysis submitted to three types of parathyroidectomy between 2010 and 2017. The primary outcome measure was relief of the symptoms and normalization of the main biochemical parameters.

RESULTS: All symptoms improved significantly after surgery, especially osteoatricular pains. iPth dropped significantly immediately and during the follow up in all 3 groups; on short term, iPth values for group C(tPtx) were significantly lower compared to the other 2 subgroups (p=0.009). Furthermore, 5 patients from group C presented iPth values <12 pg/ml one year post-surgery, though this values tend to improve after. Patients from group B and C developed most often acute postoperative hypocalcemia, and persistent hyperparathyroidism was encountered especially after sPtx(10.3%).

CONCLUSION: Significant improvement of both symptoms and biochemical parameters was noted in the majority of cases, regardless the parathyroidectomy type. tPtx is frequently followed by chronic hypoparathyroidism and subtotal parathyroidectomy is followed by a higher number of persistent and recurrent sHPT.