LONG-TERM RESULTS OF SUBTOTAL PARATHYROIDECTOMY IN PATIENTS WITH END-STAGE RENAL-DISEASE

This is a retrospective, clinical study evaluating the long-term outco me of subtotal parathyroidectomy (PTX) in 60 patients with chronic ren al failure and severe secondary hyperparathyroidism. Patients were 41 +/- 2 years aid (mean +/- SE) at the time of PTX, and followed for 69 +/- 6 months since the procedure. At the time of PTX, three patients h ad chronic renal failure, 53 had been on chronic hemodialysis, and fou r had received successful kidney transplants. In more than 80 per cent of patients, symptoms of hyperparathyroidism (bone pain and muscle we akness) resolved within weeks, and biochemical signs (hypercalcemia, a nd high plasma alkaline phosphatase and parathyroid hormone concentrat ions) returned to normal ranges within a year. Subperiosteal resorptio n, bone fractures, and soft tissue calcification frequently improved. Osteosclerosis (rugger-jersey spine), cystic bone changes, osteopenia, and vascular calcifications were, however, often unchanged or progres sive. Five patients (8%) who had either persistent or recurrent hyperp arathyroidism required additional surgical procedures, and two had sub sequent improvement. Twelve patients who had aluminum associated bone disease diagnosed later continued to progress with a high incidence of bone fractures and severe osteopenia. Cystic bone changes, especially of the carpal bones, in association with carpal tunnel syndrome, prob ably representing amyloid bone disease, also did not respond to PTX. I n conclusion, PTX is an effective surgical procedure to reverse compli cations of hyperparathyroidism in patients with end-stage renal diseas e, provided that other causes of osteodystrophy, such as aluminum or a myloid-associated bone diseases, are adequately excluded. We feel that subtotal PTX, leaving a small remnant in place, is the procedure of c hoice.