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Surgery benefits patients with renal disease, primary hyperparathyroidism
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In patients with coexisting primary hyperparathyroidism and renal disease, parathyroidectomy stopped the progression of renal function deterioration, according to recent findings in a retrospective cross-sectional study.
Francesco Tassone, MD, PhD, of Santa Croce and Carle Hospital in Cuneo, Italy, and colleagues evaluated the charts of 109 consecutive patients with primary hyperparathyroidism treated with parathyroidectomy between 1995 and 2012. The researchers extracted the following biochemistry data from the patient charts: BMI, systolic blood pressure, diastolic BP, creatinine, serum immunoreactive parathyroid hormone and 25-hydroxyvitamin D3 concentration. Participants also were tested with plain radiograph of the abdomen or ultrasound of the kidneys. The researchers used the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation to evaluate estimated glomerular filtration rate.
The researchers found that, at diagnosis, the participants had a mean eGFR of 82.4 ± 19.3 mL/min/1.72 m2. Compared with those with an eGFR lower than 60 mL/min/1.73 m2, those with eGFR of 60 mL/min/1.73 m2 or more tended to be younger (P < .0003).
In the participants with the lower eGFR, the measure did not change after parathyroidectomy compared with a decrease in eGFR in those participants with baseline eGFR of 60 mL/min/1.73 m2 or higher (P < .0002).
There was an inverse association between the difference in eGFR and postsurgery values and baseline serum creatinine (P = .0052), whereas the difference was positively correlated with baseline CKD-EPI eGFR values (P = .00062).
Multiple regression revealed that only systolic BP and baseline eGFR were independently predictive of eGFR changes.
“Our data show that surgical cure of [primary hyperparathyroidism] halts renal function worsening in patients with concomitant renal disease, thus supporting current guidelines that recommend surgery for [primary hyperparathyroidism] patients whose GFR is below 60 mL/min/1.73 m2,” the researchers wrote. “Moreover, our data also show that presurgical renal function is the most relevant predictor of renal function change after [parathyroidectomy].” – by Jennifer Byrne
Disclosure: The researchers report no relevant financial disclosures.
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