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Predictors of recurrent hyperparathyroidism after total parathyroidectomy in chronic renal failure.
Nephron Clin Pract 2003; 95(1):c15-22NC

Abstract

BACKGROUND/AIMS

Recurrent hyperparathyroidism (HPT) after total parathyroidectomy (TPTX) in chronic renal failure appears more common than might be anticipated.

METHODS

To study its predictors, we reviewed all 20 cases of TPTX performed at our hospital in a 10-year period.

RESULTS

During follow-up (median 46.8 months (range 9.3-120.3)), 15 patients had measurable PTH levels (>10 pg/ml), 7 had levels above the normal range (recurrent HPT), and 3 had PTH levels >300 pg/ml (severe recurrent HPT). Total follow-up post-TPTX was equal in those who developed recurrent HPT and others, but those with recurrent HPT had spent longer on dialysis post-TPTX (61.9 +/- 34.9 vs. 21.8 +/- 12.0 months; p = 0.001). Patients with recurrent HPT required less vitamin D supplementation during the 10 days post-TPTX (p = 0.025). Log [maximal PTH post-TPTX] correlated with duration of dialysis dependency post-TPTX (r = 0.591, p = 0.006), lowest serum calcium level during the first 30 days post-TPTX (r = 0.449, p = 0.047), and mean serum calcium during the first 30 days post-TPTX (r = 0.546, p = 0.013). Mean log [maximal PTH post-TPTX] was significantly lower in patients with ectopic calcification (p = 0.047). In multiple regression analysis, duration of dialysis post-TPTX and lowest serum calcium level during the first 30 days post-TPTX were the only independent predictors of log [maximal PTH post-TPTX].

CONCLUSION

Recurrent HPT is common following TPTX and predicted by duration of dialysis dependency post-TPTX, a measure of overall exposure to the uraemic stimulus to parathyroid hyperplasia, and the degree of early hypocalcaemia, possibly reflecting the adequacy of operative parathyroid ablation.

Authors+Show Affiliations

Renal Unit and Department of Surgery, Lister Hospital, Stevenage, Herts, UK.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

14520017

Citation

Stratton, Jon, et al. "Predictors of Recurrent Hyperparathyroidism After Total Parathyroidectomy in Chronic Renal Failure." Nephron. Clinical Practice, vol. 95, no. 1, 2003, pp. c15-22.
Stratton J, Simcock M, Thompson H, et al. Predictors of recurrent hyperparathyroidism after total parathyroidectomy in chronic renal failure. Nephron Clin Pract. 2003;95(1):c15-22.
Stratton, J., Simcock, M., Thompson, H., & Farrington, K. (2003). Predictors of recurrent hyperparathyroidism after total parathyroidectomy in chronic renal failure. Nephron. Clinical Practice, 95(1), pp. c15-22.
Stratton J, et al. Predictors of Recurrent Hyperparathyroidism After Total Parathyroidectomy in Chronic Renal Failure. Nephron Clin Pract. 2003;95(1):c15-22. PubMed PMID: 14520017.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predictors of recurrent hyperparathyroidism after total parathyroidectomy in chronic renal failure. AU - Stratton,Jon, AU - Simcock,Meredith, AU - Thompson,Hilary, AU - Farrington,Ken, PY - 2002/11/16/received PY - 2003/06/01/accepted PY - 2003/10/2/pubmed PY - 2003/10/29/medline PY - 2003/10/2/entrez SP - c15 EP - 22 JF - Nephron. Clinical practice JO - Nephron Clin Pract VL - 95 IS - 1 N2 - BACKGROUND/AIMS: Recurrent hyperparathyroidism (HPT) after total parathyroidectomy (TPTX) in chronic renal failure appears more common than might be anticipated. METHODS: To study its predictors, we reviewed all 20 cases of TPTX performed at our hospital in a 10-year period. RESULTS: During follow-up (median 46.8 months (range 9.3-120.3)), 15 patients had measurable PTH levels (>10 pg/ml), 7 had levels above the normal range (recurrent HPT), and 3 had PTH levels >300 pg/ml (severe recurrent HPT). Total follow-up post-TPTX was equal in those who developed recurrent HPT and others, but those with recurrent HPT had spent longer on dialysis post-TPTX (61.9 +/- 34.9 vs. 21.8 +/- 12.0 months; p = 0.001). Patients with recurrent HPT required less vitamin D supplementation during the 10 days post-TPTX (p = 0.025). Log [maximal PTH post-TPTX] correlated with duration of dialysis dependency post-TPTX (r = 0.591, p = 0.006), lowest serum calcium level during the first 30 days post-TPTX (r = 0.449, p = 0.047), and mean serum calcium during the first 30 days post-TPTX (r = 0.546, p = 0.013). Mean log [maximal PTH post-TPTX] was significantly lower in patients with ectopic calcification (p = 0.047). In multiple regression analysis, duration of dialysis post-TPTX and lowest serum calcium level during the first 30 days post-TPTX were the only independent predictors of log [maximal PTH post-TPTX]. CONCLUSION: Recurrent HPT is common following TPTX and predicted by duration of dialysis dependency post-TPTX, a measure of overall exposure to the uraemic stimulus to parathyroid hyperplasia, and the degree of early hypocalcaemia, possibly reflecting the adequacy of operative parathyroid ablation. SN - 1660-2110 UR - https://www.unboundmedicine.com/medline/citation/14520017/Predictors_of_recurrent_hyperparathyroidism_after_total_parathyroidectomy_in_chronic_renal_failure_ L2 - https://www.karger.com?DOI=10.1159/000073014 DB - PRIME DP - Unbound Medicine ER -