PARATHYROIDECTOMY IN CHRONIC-RENAL-FAILURE

BACKGROUND: A subset of patients who are being maintained on dialysis for end-stage renal disease develop severely symptomatic secondary hyp erparathyroidism that cannot be controlled medically. The relative mer its of two alternative surgical approaches-subtotal parathyroidectomy versus total parathyroidectomy with autotransplantation-have not been clearly elucidated. METHODS: The records of 77 patients who had renal failure and underwent parathyroid surgery between 1982 and 1993 were r etrospectively reviewed. RESULTS: Fifty-three patients (69%) underwent subtotal parathyroidectomy and 24 (31%) underwent total resection wit h autotransplantation into forearm musculature. The incidences of post operative hypocalcemia and tetany were similar in both groups, as was the recurrence rate (7%) of clinically significant hyperparathyroidism . CONCLUSIONS: Subtotal parathyroidectomy can be performed without mor tality or morbidity and provides good control of hyperparathyroidism s econdary to chronic renal failure. Total parathyroidectomy with autotr ansplantation offers no additional advantage in this difficult patient population. Most patients will require postoperative intravenous calc ium replacement. We observed a significant incidence of continued hype rparathyroidism following successful renal transplantation.