Parathyroidectomy: still the best choice for the management of severe secondary hyperparathyroidism.

Autor:	Ramos LGF; Universidade Nove de Julho, São Paulo, SP, Brazil., Cortes DDPVR; Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Serviço de Nefrologia, São Paulo, SP, Brazil., Reis LMD; Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Serviço de Nefrologia, São Paulo, SP, Brazil., Montenegro FLM; Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil., Arap SS; Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil., Brescia MDG; Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil., Custódio MR; Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Serviço de Nefrologia, São Paulo, SP, Brazil., Jorgetti V; Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Serviço de Nefrologia, São Paulo, SP, Brazil., Elias RM; Universidade Nove de Julho, São Paulo, SP, Brazil.; Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Serviço de Nefrologia, São Paulo, SP, Brazil., Moysés RMA; Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Serviço de Nefrologia, São Paulo, SP, Brazil.
Jazyk:	English; Portuguese
Zdroj:	Jornal brasileiro de nefrologia [J Bras Nefrol] 2024 Apr-Jun; Vol. 46 (2), pp. e20230024.
DOI:	10.1590/2175-8239-JBN-2023-0024en
Abstrakt:	Introduction: Management of secondary hyperparathyroidism (SHPT) is a challenging endeavor with several factors contruibuting to treatment failure. Calcimimetic therapy has revolutionized the management of SHPT, leading to changes in indications and appropriate timing of parathyroidectomy (PTX) around the world. Methods: We compared response rates to clinical vs. surgical approaches to SHPT in patients on maintenance dialysis (CKD 5D) and in kidney transplant patients (Ktx). A retrospective analysis of the one-year follow-up findings was carried out. CKD 5D patients were divided into 3 groups according to treatment strategy: parathyroidectomy, clinical management without cinacalcet (named standard - STD) and with cinacalcet (STD + CIN). Ktx patients were divided into 3 groups: PTX, CIN (cinacalcet use), and observation (OBS). Results: In CKD 5D we found a significant parathormone (PTH) decrease in all groups. Despite all groups had a higher PTH at baseline, we identified a more pronounced reduction in the PTX group. Regarding severe SHPT, the difference among groups was evidently wider: 31%, 14% and 80% of STD, STD + CIN, and PTX groups reached adequate PTH levels, respectively (p<0.0001). Concerning the Ktx population, although the difference was not so impressive, a higher rate of success in the PTX group was also observed. Conclusion: PTX still seems to be the best treatment choice for SHPT, especially in patients with prolonged diseases in unresourceful scenarios.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu