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Parathyroidectomy Halts the Deterioration of Renal Function in Primary Hyperparathyroidism

Objective: Decreased renal function has been consistently included among factors prompting recommendation for surgery in primary hyperparathyroidism (PHPT). However, most retrospective studies addressing this issue did not show an improvement in renal function after parathyroidectomy (PTX). The aim... Full description

Journal Title: The journal of clinical endocrinology and metabolism 2015, Vol.100 (8), p.3069-3073
Main Author: Tassone, Francesco
Other Authors: Guarnieri, Andrea , Castellano, Elena , Baffoni, Claudia , Attanasio, Roberto , Borretta, Giorgio
Format: Electronic Article Electronic Article
Language: English
Subjects:
Publisher: United States: Endocrine Society
ID: ISSN: 0021-972X
Link: https://www.ncbi.nlm.nih.gov/pubmed/26079781
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title: Parathyroidectomy Halts the Deterioration of Renal Function in Primary Hyperparathyroidism
format: Article
creator:
  • Tassone, Francesco
  • Guarnieri, Andrea
  • Castellano, Elena
  • Baffoni, Claudia
  • Attanasio, Roberto
  • Borretta, Giorgio
subjects:
  • Abridged Index Medicus
  • Aged
  • Aged, 80 and over
  • Blood Pressure
  • Calcium - blood
  • Cross-Sectional Studies
  • Female
  • Glomerular Filtration Rate - physiology
  • Humans
  • Hyperparathyroidism, Primary - blood
  • Hyperparathyroidism, Primary - complications
  • Hyperparathyroidism, Primary - physiopathology
  • Hyperparathyroidism, Primary - surgery
  • Kidney - physiopathology
  • Male
  • Middle Aged
  • Parathyroidectomy - statistics & numerical data
  • Renal Insufficiency, Chronic - blood
  • Renal Insufficiency, Chronic - etiology
  • Renal Insufficiency, Chronic - physiopathology
  • Renal Insufficiency, Chronic - prevention & control
  • Retrospective Studies
ispartof: The journal of clinical endocrinology and metabolism, 2015, Vol.100 (8), p.3069-3073
description: Objective: Decreased renal function has been consistently included among factors prompting recommendation for surgery in primary hyperparathyroidism (PHPT). However, most retrospective studies addressing this issue did not show an improvement in renal function after parathyroidectomy (PTX). The aim of this study was to investigate changes in renal function after PTX in PHPT patients subdivided according to renal function at diagnosis. Design: This was a retrospective cross-sectional study. Patients and Methods: We studied 109 consecutive PHPT patients before and after PTX. Biochemical evaluation included fasting total and ionized serum calcium, phosphate, creatinine, immunoreactive intact PTH, and 25-hydroxyvitamin D3 levels. Glomerular filtration rate (GFR) was assessed with the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Results: Mean (± SD) CKD-EPI estimated GFR (eGFR) at diagnosis was 82.4 ± 19.3 mL/min/1.73 m2 (median, 84.8 mL/min/1.73 m2; interquartile range, 68.5–94.2 mL/min/1.73 m2). Patients with eGFR equal to or higher than 60 mL/min/1.73 m2 (group 1, n = 95) were significantly younger than patients with eGFR lower than 60 mL/min/1.73 m2 (group 2, n = 14; P < .0003). After PTX, eGFR did not change in patients of group 2 (P = .509), whereas it was significantly reduced in patients of group 1 (P < .0002). The difference in eGFR between baseline and post-PTX values was correlated negatively with baseline serum creatinine (R = −0.27; P = .0052) and positively with baseline CKD-EPI eGFR (R = 0.32; P = .00062). At multiple regression analysis, only systolic blood pressure and baseline CKD-EPI eGFR were independent predictors of GFR variation. Conclusion: Surgical cure of PHPT halts renal function deterioration in patients with coexisting renal disease. Our study thus supports the indication for surgery in patients with eGFR less than 60 mL/min/1.73 m2, as recommended by current guidelines. Moreover, our data show that presurgical renal function is a relevant predictor of renal function after PTX.
language: eng
source:
identifier: ISSN: 0021-972X
fulltext: no_fulltext
issn:
  • 0021-972X
  • 1945-7197
url: Link


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titleParathyroidectomy Halts the Deterioration of Renal Function in Primary Hyperparathyroidism
creatorTassone, Francesco ; Guarnieri, Andrea ; Castellano, Elena ; Baffoni, Claudia ; Attanasio, Roberto ; Borretta, Giorgio
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descriptionObjective: Decreased renal function has been consistently included among factors prompting recommendation for surgery in primary hyperparathyroidism (PHPT). However, most retrospective studies addressing this issue did not show an improvement in renal function after parathyroidectomy (PTX). The aim of this study was to investigate changes in renal function after PTX in PHPT patients subdivided according to renal function at diagnosis. Design: This was a retrospective cross-sectional study. Patients and Methods: We studied 109 consecutive PHPT patients before and after PTX. Biochemical evaluation included fasting total and ionized serum calcium, phosphate, creatinine, immunoreactive intact PTH, and 25-hydroxyvitamin D3 levels. Glomerular filtration rate (GFR) was assessed with the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Results: Mean (± SD) CKD-EPI estimated GFR (eGFR) at diagnosis was 82.4 ± 19.3 mL/min/1.73 m2 (median, 84.8 mL/min/1.73 m2; interquartile range, 68.5–94.2 mL/min/1.73 m2). Patients with eGFR equal to or higher than 60 mL/min/1.73 m2 (group 1, n = 95) were significantly younger than patients with eGFR lower than 60 mL/min/1.73 m2 (group 2, n = 14; P < .0003). After PTX, eGFR did not change in patients of group 2 (P = .509), whereas it was significantly reduced in patients of group 1 (P < .0002). The difference in eGFR between baseline and post-PTX values was correlated negatively with baseline serum creatinine (R = −0.27; P = .0052) and positively with baseline CKD-EPI eGFR (R = 0.32; P = .00062). At multiple regression analysis, only systolic blood pressure and baseline CKD-EPI eGFR were independent predictors of GFR variation. Conclusion: Surgical cure of PHPT halts renal function deterioration in patients with coexisting renal disease. Our study thus supports the indication for surgery in patients with eGFR less than 60 mL/min/1.73 m2, as recommended by current guidelines. Moreover, our data show that presurgical renal function is a relevant predictor of renal function after PTX.
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subjectAbridged Index Medicus ; Aged ; Aged, 80 and over ; Blood Pressure ; Calcium - blood ; Cross-Sectional Studies ; Female ; Glomerular Filtration Rate - physiology ; Humans ; Hyperparathyroidism, Primary - blood ; Hyperparathyroidism, Primary - complications ; Hyperparathyroidism, Primary - physiopathology ; Hyperparathyroidism, Primary - surgery ; Kidney - physiopathology ; Male ; Middle Aged ; Parathyroidectomy - statistics & numerical data ; Renal Insufficiency, Chronic - blood ; Renal Insufficiency, Chronic - etiology ; Renal Insufficiency, Chronic - physiopathology ; Renal Insufficiency, Chronic - prevention & control ; Retrospective Studies
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descriptionObjective: Decreased renal function has been consistently included among factors prompting recommendation for surgery in primary hyperparathyroidism (PHPT). However, most retrospective studies addressing this issue did not show an improvement in renal function after parathyroidectomy (PTX). The aim of this study was to investigate changes in renal function after PTX in PHPT patients subdivided according to renal function at diagnosis. Design: This was a retrospective cross-sectional study. Patients and Methods: We studied 109 consecutive PHPT patients before and after PTX. Biochemical evaluation included fasting total and ionized serum calcium, phosphate, creatinine, immunoreactive intact PTH, and 25-hydroxyvitamin D3 levels. Glomerular filtration rate (GFR) was assessed with the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Results: Mean (± SD) CKD-EPI estimated GFR (eGFR) at diagnosis was 82.4 ± 19.3 mL/min/1.73 m2 (median, 84.8 mL/min/1.73 m2; interquartile range, 68.5–94.2 mL/min/1.73 m2). Patients with eGFR equal to or higher than 60 mL/min/1.73 m2 (group 1, n = 95) were significantly younger than patients with eGFR lower than 60 mL/min/1.73 m2 (group 2, n = 14; P < .0003). After PTX, eGFR did not change in patients of group 2 (P = .509), whereas it was significantly reduced in patients of group 1 (P < .0002). The difference in eGFR between baseline and post-PTX values was correlated negatively with baseline serum creatinine (R = −0.27; P = .0052) and positively with baseline CKD-EPI eGFR (R = 0.32; P = .00062). At multiple regression analysis, only systolic blood pressure and baseline CKD-EPI eGFR were independent predictors of GFR variation. Conclusion: Surgical cure of PHPT halts renal function deterioration in patients with coexisting renal disease. Our study thus supports the indication for surgery in patients with eGFR less than 60 mL/min/1.73 m2, as recommended by current guidelines. Moreover, our data show that presurgical renal function is a relevant predictor of renal function after PTX.
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abstractObjective: Decreased renal function has been consistently included among factors prompting recommendation for surgery in primary hyperparathyroidism (PHPT). However, most retrospective studies addressing this issue did not show an improvement in renal function after parathyroidectomy (PTX). The aim of this study was to investigate changes in renal function after PTX in PHPT patients subdivided according to renal function at diagnosis. Design: This was a retrospective cross-sectional study. Patients and Methods: We studied 109 consecutive PHPT patients before and after PTX. Biochemical evaluation included fasting total and ionized serum calcium, phosphate, creatinine, immunoreactive intact PTH, and 25-hydroxyvitamin D3 levels. Glomerular filtration rate (GFR) was assessed with the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Results: Mean (± SD) CKD-EPI estimated GFR (eGFR) at diagnosis was 82.4 ± 19.3 mL/min/1.73 m2 (median, 84.8 mL/min/1.73 m2; interquartile range, 68.5–94.2 mL/min/1.73 m2). Patients with eGFR equal to or higher than 60 mL/min/1.73 m2 (group 1, n = 95) were significantly younger than patients with eGFR lower than 60 mL/min/1.73 m2 (group 2, n = 14; P < .0003). After PTX, eGFR did not change in patients of group 2 (P = .509), whereas it was significantly reduced in patients of group 1 (P < .0002). The difference in eGFR between baseline and post-PTX values was correlated negatively with baseline serum creatinine (R = −0.27; P = .0052) and positively with baseline CKD-EPI eGFR (R = 0.32; P = .00062). At multiple regression analysis, only systolic blood pressure and baseline CKD-EPI eGFR were independent predictors of GFR variation. Conclusion: Surgical cure of PHPT halts renal function deterioration in patients with coexisting renal disease. Our study thus supports the indication for surgery in patients with eGFR less than 60 mL/min/1.73 m2, as recommended by current guidelines. Moreover, our data show that presurgical renal function is a relevant predictor of renal function after PTX.
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