Secondary hyperparathyroidism in patients on maintenance hemodialysis: study of optimal hemopurification and parathyroidectomy.

We have found that hemofiltration and direct hemoperfusion combined with hemodialysis removed significant amounts of parathyroid hormone. Hemofiltration and direct hemoperfusion combined with hemodialysis seemed to have better effects on secondary hyperparathyroidism. Surgical parathyroidectomy is indicated when medical parathyroidectomy has failed to prevent progressive bone disease. We had ten patients with refractory secondary hyperparathyroidism. In these patients, subtotal parathyroidectomy was attempted. The results obtained were: 1) Subtotal parathyroidectomy was successful in all patients. 2) Preoperative serum parathyroid hormone values were useful for diagnosis of secondary hyperparathyroidism. 3) The average serum N and C-terminal parathyroid hormone values measured preoperatively were 4,491.00 +/- 892.13 pg/ml and 4,580.00 +/- 474.48 pg/ml, respectively. 4) The average N and C-terminal parathyroid hormone values measured postoperatively were 298.60 +/- 128.68 pg/ml and 2,631.00 +/- 719.51 pg/ml, respectively.