Endocrinol Metab.  2019 Dec;34(4):367-373. 10.3803/EnM.2019.34.4.367.

Impact of Subtotal Parathyroidectomy on Clinical Parameters and Quality of Life in Hemodialysis Patients with Secondary Hyperparathyroidism

• El-kholey
• Ibrahim GE
• Elshahat O
• El-Kannishy G

• KMID: 2466255
• DOI: http://doi.org/10.3803/EnM.2019.34.4.367

Abstract

BACKGROUND
Impairment of quality of life (QOL) is a key clinical characteristic of patients with end-stage renal disease (ESRD), and can be especially severe in the presence of secondary hyperparathyroidism (SHPT). Despite the proven success of parathyroidectomy (PTX) in controlling biochemical parameters in patients with severe SHPT, evidence is lacking regarding the effects of PTX on various clinical outcomes, including QOL.
METHODS
Twenty ESRD patients on maintenance hemodialysis with SHPT who underwent subtotal PTX were included in an observational longitudinal study. All studied patients underwent history-taking, clinical examinations, and laboratory investigations, including a complete blood count and measurements of serum calcium, phosphorus, magnesium, parathyroid hormone (PTH), and albumin levels preoperatively and at 3 months postoperatively. QOL was assessed before surgery and at 3 months after surgery using the Kidney Disease Quality of Life 36-Item Short-Form instrument.
RESULTS
After PTX, significant decreases in serum PTH and phosphorus levels were observed, as well as a significant increase in serum magnesium levels. Significant weight gain and improvements of QOL were also detected postoperatively.
CONCLUSION
Subtotal PTX seems to be an efficient alternative to medical management in uncontrolled cases of SHPT, as it is capable of controlling the biochemical derangements that occur in hyperparathyroidism. Furthermore, PTX had a beneficial effect on clinical outcomes, as shown by weight gain and improvements in all QOL scales.

Keyword

Quality of life; Renal dialysis; Hyperparathyroidism, secondary; Parathyroidectomy

MeSH Terms

Blood Cell Count
Calcium
Humans
Hyperparathyroidism
Hyperparathyroidism, Secondary*
Kidney Diseases
Kidney Failure, Chronic
Longitudinal Studies
Magnesium
Parathyroid Hormone
Parathyroidectomy*
Phosphorus
Quality of Life*
Renal Dialysis*
Weight Gain
Weights and Measures
Calcium
Magnesium
Parathyroid Hormone
Phosphorus

Reference

1. Rodriguez M, Lorenzo V. Parathyroid hormone, a uremic toxin. Semin Dial. 2009; 22:363–368. PMID: 19708982.

2. de Brito Galvao JF, Nagode LA, Schenck PA, Chew DJ. Calcitriol, calcidiol, parathyroid hormone, and fibroblast growth factor-23 interactions in chronic kidney disease. J Vet Emerg Crit Care (San Antonio). 2013; 23:134–162. PMID: 23566108.

3. Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl. 2009; (113):S1–S130.

4. Trombetti A, Stoermann C, Robert JH, Herrmann FR, Pennisi P, Martin PY, et al. Survival after parathyroidectomy in patients with end-stage renal disease and severe hyperparathyroidism. World J Surg. 2007; 31:1014–1021. PMID: 17420960.

5. Valente-Da-Silva HG, Maya MCA, Moreira AS. Parathyroidectomy in chronic kidney disease: effects on weight gain and on quality of life improvement. Rev Col Bras Cir. 2017; 44:263–269. PMID: 28767802.

6. RAND Health Care. Kidney Disease Quality of Life Instrument (KDQOL) [Internet]. Santa Monica (CA): RAND Corp.;2019. cited 2019 Oct 24. Available from: https://www.rand.org/health-care/surveys_tools/kdqol.html.

7. Ma TL, Hung PH, Jong IC, Hiao CY, Hsu YH, Chiang PC, et al. Parathyroidectomy is associated with reduced mortality in hemodialysis patients with secondary hyperparathyroidism. Biomed Res Int. 2015; 2015:639587. PMID: 26064934.

8. Peters BS, Jorgetti V, Martini LA. Body composition changes in haemodialysis patients with secondary hyperparathyroidism after parathyroidectomy measured by conventional and vector bioimpedance analysis. Br J Nutr. 2006; 95:353–357. PMID: 16469153.

9. Dousdampanis P, Trigka K, Fourtounas C. Hypomagnesemia, chronic kidney disease and cardiovascular mortality: pronounced association but unproven causation. Hemodial Int. 2014; 18:730–739. PMID: 24641780.

10. Brown EM, MacLeod RJ. Extracellular calcium sensing and extracellular calcium signaling. Physiol Rev. 2001; 81:239–297. PMID: 11152759.

11. Ohya M, Negi S, Sakaguchi T, Koiwa F, Ando R, Komatsu Y, et al. Significance of serum magnesium as an independent correlative factor on the parathyroid hormone level in uremic patients. J Clin Endocrinol Metab. 2014; 99:3873–3878. PMID: 24937533.

12. Sanda S, Schlingmann KP, Newfield RS. Autosomal dominant hypoparathyroidism with severe hypomagnesemia and hypocalcemia, successfully treated with recombinant PTH and continuous subcutaneous magnesium infusion. J Pediatr Endocrinol Metab. 2008; 21:385–391. PMID: 18556971.

13. Fang L, Tang B, Hou D, Meng M, Xiong M, Yang J. Effect of parathyroid hormone on serum magnesium levels: the neglected relationship in hemodialysis patients with secondary hyperparathyroidism. Ren Fail. 2016; 38:50–56. PMID: 26671274.

14. Katopodis KP, Koliousi EL, Andrikos EK, Pappas MV, Elisaf MS, Siamopoulos KC. Magnesium homeostasis in patients undergoing continuous ambulatory peritoneal dialysis: role of the dialysate magnesium concentration. Artif Organs. 2003; 27:853–857. PMID: 12940910.

15. Massry SG. The toxic effects of parathyroid hormone in uremia. Semin Nephrol. 1983; 3:306–328.

16. Ohnishi M, Razzaque MS. Dietary and genetic evidence for phosphate toxicity accelerating mammalian aging. FASEB J. 2010; 24:3562–3571. PMID: 20418498.

17. Peters BS, Jorgetti V, Martini LA. Body composition changes in haemodialysis patients with secondary hyperparathyroidism after parathyroidectomy measured by conventional and vector bioimpedance analysis. Br J Nutr. 2006; 95:353–357. PMID: 16469153.

18. Chow TL, Chan TT, Ho YW, Lam SH. Improvement of anemia after parathyroidectomy in Chinese patients with renal failure undergoing long-term dialysis. Arch Surg. 2007; 142:644–648. PMID: 17638802.

19. Malindretos P, Sarafidis P, Lazaridis A, Nikolaidis P. A study of the association of higher parathormone levels with health-related quality of life in hemodialysis patients. Clin Nephrol. 2012; 77:196–203. PMID: 22377250.

20. Cheng SP, Lee JJ, Liu TP, Yang TL, Chen HH, Wu CJ, et al. Parathyroidectomy improves symptomatology and quality of life in patients with secondary hyperparathyroidism. Surgery. 2014; 155:320–328. PMID: 24035616.

21. Bratucu MN, Garofil ND, Radu PA, Paic V, Zurzu M, Goleanu V, et al. Surgical attitude in patients with secondary hyperparathyroidism undergoing dialysis. Chirurgia (Bucur). 2015; 110:418–424. PMID: 26531784.