KBC Zvezdara University Clinical Centre, Clinic for Surgery "Nikola Spasic", D. Tucovica 161, 11000 Belgrade, Serbia.
Langenbecks Arch Surg. 2012 Mar;397(3):413-20. doi: 10.1007/s00423-011-0901-9. Epub 2012 Jan 13.
The National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF-K/DOQI™) 2003 and Kidney Disease: Improving Global Outcomes (KDIGO) 2009 have established guidelines for the treatement of secondary hyperparathyroidism. This study evaluated the impact of parathyroidectomy to achieve recommended values for parathyroid hormone, calcium, phosphorus and CaxPO(4) product in dialysis patients with severe secondary hyperparathyroidism that is resistant to medical treatment.
This study included 43 consecutive patients who underwent parathyroidectomy for a severe form of secondary hyperparathyroidism (SHPT) that is unresponsive to medical treatment. The serum iPTH, calcium and phosphorus levels were measured prior to surgery, every morning after surgery for 5 days and on the first, sixth and eighth postoperative months.
Following parathyroidectomy, a significant decline in iPTH values was observed in all patients; however, after the 8-month study period, only one of these patients achieved a serum iPTH concentration within the K/DOQI recommended target range. Unlike iPTH, targeting for calcium, phosphorus and CaxPO(4) at the last follow-up were 55.8%, 60.5% and 93%, respectively. These values indicated a significant improvement in comparison to preoperative percentages. In regards to the KDIGO recommended guidelines, the iPTH levels did not significantly change at the end of our study compared to preoperative values; however, calcium levels significantly declined and phosphorus levels significantly improved compared to preoperative values.
Although the majority of patients fail to reach recommended iPTH values, parathyroidectomy remains a valuable tool to attain these NKF-K/DOQI recommendations for serum calcium, phosphorus and CaxPO(4) in dialysis patients with secondary hyperparathyroidism resistant to medical therapy. Parathyroidectomy was shown to be an inadequate intervention for achieving KDIGO recommendations.
美国国家肾脏基金会肾脏病预后质量倡议（NKF-K/DOQI™）2003 年和肾脏病：改善全球预后（KDIGO）2009 年为继发性甲状旁腺功能亢进症的治疗制定了指南。本研究评估了甲状旁腺切除术对治疗对药物治疗无反应的严重继发性甲状旁腺功能亢进症（SHPT）患者达到甲状旁腺激素、钙、磷和 CaxPO(4)乘积推荐值的影响。
本研究纳入 43 例因药物治疗无反应而接受甲状旁腺切除术治疗严重继发性甲状旁腺功能亢进症（SHPT）的连续患者。手术前、手术后 5 天每天早上以及手术后第 1、6 和 8 个月测量血清 iPTH、钙和磷水平。
甲状旁腺切除术后，所有患者的 iPTH 值均显著下降；然而，在 8 个月的研究期间，只有 1 例患者的血清 iPTH 浓度达到 K/DOQI 推荐目标范围。与 iPTH 不同，在最后一次随访时，钙、磷和 CaxPO(4)的目标值分别为 55.8%、60.5%和 93%。与术前百分比相比，这些值表明有显著改善。关于 KDIGO 推荐的指南，与术前值相比，我们研究结束时 iPTH 水平没有显著变化；然而，与术前值相比，钙水平显著下降，磷水平显著改善。
尽管大多数患者未能达到推荐的 iPTH 值，但甲状旁腺切除术仍然是一种有价值的工具，可以实现 NKF-K/DOQI 对药物治疗无反应的继发性甲状旁腺功能亢进症透析患者的血清钙、磷和 CaxPO(4)的推荐值。甲状旁腺切除术被证明不足以实现 KDIGO 的建议。
