Venkateshappa Bhoomika, Narayanaswamy Prasanna, Venkata Koti Reddy Kandula, Madupuri Gurupriya, Boreddy Varalakshmi, Pavuluri Aiswarya Lakshmi, Ram Rapur, Vishnubotla Siva Kumar
Sri Venkateswara Institute of Medical Sciences, Tirupati, India.
Ir J Med Sci. 2025 Sep 8. doi: 10.1007/s11845-025-04034-y.
Information on tertiary hyperparathyroidism (THPTH) among chronic kidney disease (CKD) patients on haemodialysis in developing countries such as India is limited, and the mortality among them remains a query.
This was a prospective cohort study conducted in at a tertiary care centre from June 2017 to June 2022. The index of suspicion for tertiary hyperparathyroidism was when investigations revealed high serum calcium and high alkaline phosphatase along with new onset of body aches, joint pains, and difficulty in walking. Patients, with above clinical features, were considered for 99 m Tc-Sestamibi scan and high-resolution ultrasound of the neck, when serum parathormone was > 600 pg/mL. Those patients diagnosed with tertiary hyperparathyroidism were followed up for 5 years.
The incidence of tertiary hyperparathyroidism among CKD patients was 13.4%. The mean age of CKD stage 5 patients with tertiary hyperparathyroidism was 55.17 ± 11.1 years. The observation from our study was the mean survival time among patients who underwent parathyroidectomy and among patients who received cinacalcet was almost similar, whereas the mean survival time among patients who received phosphate binders was lower. However, the survival rate among patients on cinacalcet and who underwent parathyroidectomy were not statistically significant.
There were no cross-sectional studies on prevalence of tertiary hyperparathyroidism in India as per our knowledge, although the prospective design, large sample size, PTH stratification, and frequent measurements of a comprehensive panel of mineral metabolites are strengths of the current study.
在印度等发展中国家，接受血液透析的慢性肾脏病（CKD）患者中关于三发性甲状旁腺功能亢进症（THPTH）的信息有限，且他们的死亡率仍是个问题。
这是一项于2017年6月至2022年6月在一家三级护理中心进行的前瞻性队列研究。当检查发现血清钙升高、碱性磷酸酶升高以及出现新的身体疼痛、关节疼痛和行走困难时，怀疑为三发性甲状旁腺功能亢进症。具有上述临床特征的患者，当血清甲状旁腺激素>600 pg/mL时，考虑进行99m锝-甲氧基异丁基异腈扫描和颈部高分辨率超声检查。那些被诊断为三发性甲状旁腺功能亢进症的患者随访5年。
CKD患者中三发性甲状旁腺功能亢进症的发病率为13.4%。患有三发性甲状旁腺功能亢进症的CKD 5期患者的平均年龄为55.17±11.1岁。我们研究的观察结果是，接受甲状旁腺切除术的患者和接受西那卡塞治疗的患者的平均生存时间几乎相似，而接受磷结合剂治疗的患者的平均生存时间较低。然而，接受西那卡塞治疗的患者和接受甲状旁腺切除术的患者的生存率在统计学上无显著差异。
据我们所知，印度尚无关于三发性甲状旁腺功能亢进症患病率的横断面研究，尽管前瞻性设计、大样本量、甲状旁腺激素分层以及对一组综合矿物质代谢物的频繁测量是本研究的优势。
