Outcomes of parathyroidectomy versus calcimimetics for secondary hyperparathyroidism and kidney transplantation: a propensity-matched analysis
Autor: | Koh, Ezra Y., van der Plas, Willemijn Y., Dulfer, Roderick R., Pol, Robert A., Kruijf, Schelto, Rotmans, Joris I., Appelman-Dijkstra, Natasha, Schepers, Abbey, de Borst, Martin H., Hoorn, Ewout J., van Ginhoven, Tessa, Nieveen van Dijkum, Els J. M., Vogt, Liffert, Engelsman, Anton F., von Forstner, Philip, Gispen, Carlijn |
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Přispěvatelé: | Surgery, AII - Inflammatory diseases, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, ACS - Microcirculation, APH - Health Behaviors & Chronic Diseases, Nephrology, Internal Medicine, Groningen Kidney Center (GKC), Groningen Institute for Organ Transplantation (GIOT), Guided Treatment in Optimal Selected Cancer Patients (GUTS), Lifestyle Medicine (LM), Basic and Translational Research and Imaging Methodology Development in Groningen (BRIDGE) |
Jazyk: | angličtina |
Rok vydání: | 2020 |
Předmět: |
Parathyroidectomy
medicine.medical_specialty medicine.medical_treatment Urology CINACALCET HYDROCHLORIDE Parathyroid hormone 030230 surgery THERAPY CLASSIFICATION Kidney transplantation 03 medical and health sciences 0302 clinical medicine medicine MANAGEMENT Secondary hypersparathyroidism Dialysis business.industry Calcimimetics STAGE RENAL-DISEASE medicine.disease Cardiac surgery Secondary hyperparathyroidism Cinacalcet Hydrochloride 030220 oncology & carcinogenesis SURVIVAL Surgery business Abdominal surgery |
Zdroj: | Langenbeck s archives of surgery / Deutsche Gesellschaft fur Chirurgie, 405(6), 851-859. Springer Verlag Langenbecks Archives of Surgery, 405(6), 851-859. Springer-Verlag Langenbeck's Archives of Surgery, 405(6), 851-859. SPRINGER Langenbecks Archives of Surgery, 405(6), 851-859. SPRINGER |
ISSN: | 1435-2443 |
Popis: | Purpose: Calcimimetics are currently indicated for severe secondary hyperparathyroidism (SHPT). However, the role of parathyroidectomy (PTX) for these patients is still under debate, and its impact on subsequent kidney transplantation (KTX) is unclear. In this study, we compare the outcomes of kidney transplantation after PTX or medical treatment. Methods: Patients who underwent KTX and had SHPT were analyzed retrospectively. Two groups were selected (patients who had either PTX or calcimimetics prior to KTX) using a propensity score for sex, age, donor type, and parathyroid hormone levels (PTH) during dialysis. The primary outcome was graft failure, and secondary outcomes were surgical KTX complications, survival, serum PTH, serum calcium, and serum phosphate levels post-KTX. Results: Matching succeeded for 92 patients. After PTX, PTH was significantly lower on the day of KTX as well as at 1 and 3 years post-KTX (14.00 pmol/L (3.80–34.00) vs. 71.30 pmol/L (30.70–108.30), p < 0.01, 10.10 pmol/L (2.00–21.00) vs. 32.35 pmol/L (21.58–51.76), p < 0.01 and 13.00 pmol/L (6.00–16.60) vs. 19.25 pmol/L (13.03–31.88), p = 0.027, respectively). No significant differences in post-KTX calcium and phosphate levels were noted between groups. Severe KTX complications were more common in the calcimimetics group (56.5% vs. 30.4%, p = 0.047). There were no differences in 10-year graft failure and overall survival. Conclusion: PTX resulted in lower PTH after KTX in comparison to patients who received calcimimetics. Severe complications were more common after calcimimetics, but graft failure and overall survival were similar. |
Databáze: | OpenAIRE |
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