Parathyroidectomy for dialysis patients in the era of calcimimetics: The surgeons’ point of view

Calcimimetics is a new drug for lowering serum parathyroid hormone (PTH), calcium and phosphate in patients with hyperparathyroidism (HPT) on long-term dialysis. It became available on market in 2006. The impact of calcimimetics on the treatment by parathyroidectomy (PTx) was reviewed from the surge...

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Bibliographic Details
Published in:Journal of the Chinese Medical Association 2022-03, Vol.85 (3), p.279-285
Main Authors: Lee, Chen-Hsen, Chen, Jui-Yu, Kuo, Po-Chung, Chen, Wei-Ting
Format: Article
Language:English
Subjects:
Humans
Hyperparathyroidism, Secondary - drug therapy
Hyperparathyroidism, Secondary - etiology
Hyperparathyroidism, Secondary - surgery
Parathyroid Hormone
Parathyroidectomy - adverse effects
Parathyroidectomy - methods
Quality of Life
Renal Dialysis - adverse effects
Retrospective Studies
Surgeons
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Summary:Calcimimetics is a new drug for lowering serum parathyroid hormone (PTH), calcium and phosphate in patients with hyperparathyroidism (HPT) on long-term dialysis. It became available on market in 2006. The impact of calcimimetics on the treatment by parathyroidectomy (PTx) was reviewed from the surgeons’ point of view. Cure of renal HPT by calcimimetics is not feasible, but calcimimetics can improve preoperative cardiac ventricle ejection fractions by lowering serum PTH. Heart failure is not necessarily a contraindication for PTx. PTx should be done before irreversible organ damage occurs. Limb gangrenes is an ominous sign and should be prevented by frequent checkup for peripheral arterial circulation. The impact of renal osteodystrophy on the quality of life and as indirect cause of mortality deserves more attention in patients with renal HPT. Delayed referral to PTx leads to more complicated patients. A consensus between nephrologists and surgeons about propitious timing for PTx is necessary. Future prospect on the surgical treatment of renal HPT is proposed. Supplemental figure; http://links.lww.com/ASAIO/A782
ISSN:1726-4901
1728-7731
DOI:10.1097/JCMA.0000000000000694