RESULTS OF SURGICAL-TREATMENT OF RENAL HYPERPARATHYROIDISM

Objective: To assess the outcome of parathyroidectomy for renal failur e-related hyperparathyroidism. Design: A retrospective analysis with a mean follow-up of 4.34 years of a case series of 67 consecutive patie nts with renal failure-associated hyperparathyroidism. Setting: All pa tients were operated on at the University Hospital of Wales and Cardif f Royal Infirmary between October 1981 and December 1991. Patients: Of the 67 consecutive patients, 35 were receiving hemodialysis and 32 ha d received a renal transplant. Intervention: Total parathyroidectomy w ith autotransplantation was performed in 52 patients and subtotal para thyroidectomy was performed in 15. Main Outcome Measures: Symptomatic improvement after parathyroidectomy, the normalization of biochemical parameters, and the rate of recurrent hyper parathyroidism after parat hyroidectomy. Results: Symptomatic improvement after parathyroidectomy occurred in 81% of hemodialysis patients and in 72% of transplant pat ients. The best predictor for successful relief of skeletal pain after parathyroidectomy was an elevated preoperative alkaline phosphatase l evel. Recurrent hyperparathyroidism developed in four of 38 patients a fter total parathyroidectomy with autotransplantation and in one of 14 surviving patients after subtotal parathyroidectomy. All five patient s with recurrent disease were hemodialysis patients (22%). Conclusions : Transplant patients usuary present with less severe disease, have be tter normalization of biochemical parameters after parathyroidectomy, and rarely develop recurrent hyperparathyroidism compared with hemodia lysis patients. Both total parathyroidectomy with autotransplantation and subtotal parathyroidectomy result in good control of renal hyperpa rathyroidism with excellent improvement of symptoms.