Trunzo Joseph A, McHenry Christopher R, Schulak James A, Wilhelm Scott M
University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio, USA.
Surgery. 2008 Dec;144(6):915-8; discussion 919. doi: 10.1016/j.surg.2008.07.026.
It has been suggested that parathyroidectomy for hyperparathyroidism (HPT) in end-stage renal disease (ESRD) may result in improvement in anemia and the response to erythropoiesis-stimulating drugs. This study examines the effect parathyroidectomy had on erythropoietin (EPO) dosing requirements and anemia in ESRD.
A retrospective review was conducted. Patients were included if pre-operative and 12 month postoperative hemoglobin (Hg) and hematocrit (Hct) levels were available and they did not receive a kidney transplant or have failure of parathyroidectomy during the follow-up. Erythropoietin (EPO) dose and serum levels of calcium, phosphorus, alkaline phosphatase, albumin, and parathyroid hormone (PTH) were also obtained. Other data collections were at 1 and 2 mos. postoperatively.
Thirty-seven patients met inclusion criteria. Parathyroidectomy resulted in decreased PTH from 1,871 +/- 236 (mean +/- SEM) to 172 +/- 29 pg/mL (P < .001) at 1 year. EPO dosing requirement showed a profound decrease from 10,086 +/- 1,721 to 3,514 +/- 620 units/week (P < .05). Hb and Hct levels followed an upward trend at 12 mos (11.4 +/- 0.3 to 12.1 +/- 0.2 g/dL and 35.7 +/- 1.0 to 37.1 +/- 0.6%, respectively).
In ESRD, parathyroidectomy for HPT improves anemia and decreases requirements for exogenous erythropoietin suggesting either increased endogenous EPO production or improved response. As a result, we propose refractory ESRD-associated anemia as a secondary indication for parathyroidectomy resection in this population.
有人提出，终末期肾病（ESRD）患者因甲状旁腺功能亢进（HPT）而进行甲状旁腺切除术可能会改善贫血状况以及对促红细胞生成药物的反应。本研究探讨了甲状旁腺切除术对ESRD患者促红细胞生成素（EPO）剂量需求和贫血的影响。
进行了一项回顾性研究。纳入标准为有术前及术后12个月的血红蛋白（Hg）和血细胞比容（Hct）水平数据，且在随访期间未接受肾移植或甲状旁腺切除失败的患者。还获取了促红细胞生成素（EPO）剂量以及血清钙、磷、碱性磷酸酶、白蛋白和甲状旁腺激素（PTH）水平。其他数据收集于术后1个月和2个月。
37例患者符合纳入标准。甲状旁腺切除术后1年，PTH从1,871±236（均值±标准误）降至172±29 pg/mL（P<.001）。EPO剂量需求从10,086±1,721单位/周大幅降至3,514±620单位/周（P<.05）。12个月时，Hb和Hct水平呈上升趋势（分别从11.4±0.3升至12.1±0.2 g/dL和从35.7±1.0升至37.1±0.6%）。
在ESRD患者中，因HPT进行甲状旁腺切除术可改善贫血状况并降低对外源性促红细胞生成素的需求，这表明内源性EPO生成增加或反应性改善。因此，我们建议将难治性ESRD相关贫血作为该人群甲状旁腺切除术的次要指征。
