Recurrence of hyperparathyroidism after total parathyroidectomy and autotransplantation in peritoneal dialysis patients

Objective:To evaluate the effectiveness of total parathyroidectomy (PTX) wi th autotransplantation in the treatment of secondary hyperparathyroidism (H PT), and to assess recurrence rate of HPT in this peritoneal dialysis (PD) population. Design: A retrospective study in a single home PD unit. Patients: Between 1994 and 1998, 19 of 574 patients on PD underwent PTX for treatment of secondary HPT. Main Outcome Measures:Clinical and biochemical improvement, recurrence of H PT, improvement in anemia post-PTX. Results: Nineteen (3.3%) patients required PTX between 1994 and 1998. These 5 men and 14 women ranged in age from 22 to 66 years; they had been on mai ntenance Po pre-PTX for 47.5 +/- 38.1 months, and were followed for 26.1 +/ - 15.5 months post-PTX. Sixteen patients had temporary hypocalcemia that wa s managed by oral (n = 10) or intravenous (n = 6) calcium supplements and c alcitriol, while 3 patients had severe "hungry bone" syndrome postoperative ly. One patient had recurrent laryngeal nerve palsy post-PTX. Bone pain dis appeared in ail 12 patients. Pruritus improved in 12/13 patients; fatigue i mproved in 15/16 patients. Comparison showed significant differences betwee n hemoglobin and hematocrit values 1 month pre-PTX and 12 months post-PTX ( p < 0.05). Parathyroid hormone (PTH) level in 15 (79%) patients returned to normal (Euro 7.6 pmol/L) during the first month post-PTX. In 5/12 (42%) pa tients, PTH level was less than or equal to 7.6 pmol/L 2 years post-PTX, wh ile in 2/12 (17%), PTH was > 22.8 pmol/L (three times normal) 2 years post- PTX, and 3/5 (60%) patients had a PTH > 22.8 pmol/L 3 years post-PTX. Conclusions:Total PTX with autotransplantation is associated with a tendenc y for recurrence of HPT. Our findings suggest that total PTX with autotrans plantation may be an ineffective procedure in controlling HPT over the long term.