1. Effects of Parathyroidectomy on Anemia in Patients with End-Stage Renal Disease
Sergey V. Veretennikov and Michael J. Campbell, MD
University of California, Davis Medical Center
Section of Endocrine Surgery
INTRODUCTION
RESULTS
CONCLUSIONS
Chronic kidney disease (CKD) affects approximately 20 million Americans.
Almost 900,000 patients have end-stage renal disease (ESRD).
Patients with CKD often suffer from anemia due to poor iron utilization and erythropoietin (EPO) resistance.
Patients with CKD frequently develop elevated parathyroid hormone (PTH) levels secondary to decreased conversion of vitamin D to its active form and decreased excretion of phosphate.
This is termed secondary hyperparathyroidism
High PTH levels may contribute to EPO resistance, resulting in worsening anemia refractory to artificial EPO supplementation.
Current treatment options for secondary hyperparathyroidism include the use of calcimimetics (e.g. cinacalcet) or parathyroidectomy.
We identified 19 patient who underwent 20 operations and met our inclusion criteria
The mean pre-operative PTH was pg/mL.
The mean post-operative PTH was pg/mL.
The mean pre-operative hemoglobin was 11.6 gm/dL.
The mean post-operative hemoglobin was 12.3 gm/dL.
The mean pre-operative hematocrit is 34.5%.
The mean post-operative hematocrit was 37.4 %.
Parathyroidectomy is a viable method to reduce PTH levels, especially in those patients with disease refractory to medical therapy.
Successful parathyroidectomy does not appear to improve anemia in patients with renal hyperparathyroidism.
Larger studies incorporating control patients are needed to better evaluate the effect of parathyroidectomy on patients with ESRD.
Limitations
Our small sample size limited our statistical power.
We have limited follow-up data on our patients which decreased our ability to detect differences in pre-op and post-op Hgb and Hct.
We do have information on the dose of EPO pre- and post-operatively at this time.
OBJECTIVES
REFERENCES
The purpose of this study is to evaluate the effect of parathyroidectomy on hemoglobin (Hgb) and hematocrit (Hct) in patients with ESRD.
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 Jul;142(7):644–8.
Rao DS, Shih MS, Mohini R. Effect of serum parathyroid hormone and bone marrow fibrosis on the response to erythropoietin in uremia. N Engl J Med. 1993;328(3):
Nichols P, Owen JP, Ellis HA, Farndon JR, Kelly PJ, Ward MK. Parathyroidectomy in chronic renal failure: a nine-year follow-up study. Q J Med Nov;77(283):1175–1193.
Chen C, Wu H, Zhong L, Wang X, Xing Z-J, Gao B-H. Impacts of parathyroidectomy on renal anemia and nutritional status of hemodialysis patients with secondary hyperparathyroidism. International Journal of Clinical and Experimental Medicine. 2015;8(6):
Bhadada SK, Arya AK, Parthan G, Singh P. The resolution of anemia after curative parathyroidectomy is sustained even after a decade. Indian Journal of Endocrinology and Metabolism. 2015;19(5): doi: /
MATERIALS AND METHODS
Review of all patients with ESRD receiving dialysis who had a parathyroidectomy between January 2005 and December 2015 using the EMR system.
Hgb and Hct values measured preoperatively and then 1 month and 6 months after surgery were compared using a students t-test