A strategy change in the treatment of end-stage renal disease related hyperparathyroidism after the introduction of calcimimetics: a retrospective observational study

Plas, W.Y. van der (Willemijn) (2016) A strategy change in the treatment of end-stage renal disease related hyperparathyroidism after the introduction of calcimimetics: a retrospective observational study. thesis, Medicine.

Text PlasvanderWY.pdf Restricted to Registered users only Download (872kB)

Abstract

Hyperparathyroidism (HPT), both secondary and tertiary, is a common abnormality in patients with end stage renal disease (ESRD). It is characterized by calcium-phosphate imbalances and elevated serum parathormone (PTH) levels and has been associated with severe bone disorders, cardiovascular complications and increased mortality. Since the introduction of calcimimetics in 2004, treatment of renal HPT has dramatically shifted from surgery to predominantly medical therapy. The aim of this study was to evaluate the impact of this change of management on the renal HPT patient population before undergoing (sub)total parathyroidectomy (PTx). A retrospective cohort study was conducted. All patients with secondary or tertiary HPT undergoing PTx between 1991-2015 were included. Patient characteristics prior to surgery as well as pre- and postoperative laboratory values, postoperative complications and weight of the resected parathyroid glands were recorded and collected in a database. Two groups of patients were compared: Group A, who underwent PTx before January 2005 and group B, who underwent PTx after 2005, since Cinacalcet was first prescribed in the UMCG in 2005. We found a 22-month delay of surgery in group B compared to group A. Also, patients of group B still presented with continuously elevated preoperative PTH values, despite medical treatment. Furthermore, postoperative complication rates were very low and we demonstrated that after PTx, PTH levels decreased drastically. In conclusion, the introduction of calcimimetics is associated with a 22-month delay of surgery with continuously elevated preoperative PTH levels whilst parathyroid surgery, even in a fragile population, is considered a safe and effective procedure.

Item Type:	Thesis (Thesis)
Supervisor name:	Under the supervision of: and Kruijff, Dr. Schelto and Afdeling Oncologische Chirurgie and Universitair Medisch Centrum Groningen (UMCG)
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 11:03
Last Modified:	25 Jun 2020 11:03
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/2292

Actions (login required)

View Item