Parathyroidectomy in chronic renal failure: Short- and long-term results on parathyroid function, blood pressure and anemia

To evaluate the long-term results of parathyroidectomy (PTX) on parathyroid function, blood pressure and anemia, data of 45 patients with secondary Hy perparathyroidism in dialysis who had undergone PTX were collected retrospe ctively from 8 different dialysis units. The patients, 25 M and 20 F, mean age 56 +/- 11 years, who were followed up for an average period of 3.3 +/- 2.3 years, were divided into four groups according to the surgical procedur e: 19 patients had had a subtotal PTX; 10 patients had undergone total PTX with autotransplantation (AT); 10 patients had had total PTX without AT, an d 6 patients had undergone partial PTX. Taking a reduction in intact PTH > 50% as sign of successful PIX, only 5 patients did not attain this result. Considering values of PTH between 20 and 200 pg/ml at the mid-term observat ion (1-2 years) as the optimal result, values under 20 pg/ml as an expressi on of permanent hypoparathyroidism, and those above 200 pg/ml as indicating persistent/recurrent hyperparathyroidism, 65.5% of patients operated with subtotal PTX and total PTX + AT had a therapeutic success, versus 31.2% of patients in the other two groups, due to excess permanent hypoparathyroidis m and persistent/recurrent hyperparathyroidism; 20 of 45 patients with preo perative hypertension experienced a statistically and clinically significan t decrease in blood pressure levels. An increase in serum hemoglobin was al so observed, despite a reduction of administered erythropoietin. in conclus ion, the results of PTX obtained from this multicenter study are comparable to those reported by single leading centers. Recommended surgical procedur es are subtotal PTX and total PTX with AT. The fall in blood pressure in hy pertensive patients is clinically significant, and improvement in anemia is also observed with a reduction in erythropoietin dosage. Copyright (C) 200 1 S. Karger AG, Basel.