Multicenter study on parathyroidectomy (PTX) in Italy: preliminary results.

Abstract

BACKGROUND:

When medical therapy is unable to achieve biochemical control of secondary hyperparathyroidism, parathyroidectomy (PTX) is indicated, fortunately in a minority of patients. Thus, data on PTX prevalence and biochemical control are limited and, in particular in Italy, date back to 1999.

METHODS:

We designed a prospective, observational and multicenter study to collect data from dialysis units distributed throughout the Italian regions. Clinical data were collected with a dedicated data sheet.

RESULTS:

From January to December 2010, 149 Centers serving a total of 12,515 patients provided data on 528 living PTX cases (PTX prevalence = 4.2%). Prevalence was higher in hemo- than in peritoneal dialysis (4.5 vs. 1.9%, X2 = 21.52; p < 0.001), with non-significant regional differences (range 0.8-7.4%). PTX patients were younger (57.6 ± 12.5 vs. 67.1 ± 14.5 years; p < 0.001), more frequently female (56 vs. 38%, X2 = 68.05, p < 0.001) and had been on dialysis for a longer time (14.63 ± 8.37 vs. 4.8 ± 6.0 years, p < 0.001) compared to the 11,987 who did not undergo neck surgery. Median time since surgery was 6.0 years (3.0-9.0; 50%, IQR). The most frequent type of surgery was subtotal PTX (sPTX = 55.0%), significantly higher than total PTX (tPTX = 38.7%) or total PTX plus auto-transplantation (aPTX = 6.3%) (X2 = 5.18; Bonferroni post-hoc test, sPTX vs. tPTX + aPTX = p < 0.05). As for parathyroid hormone (PTH), calcium and phosphate control, cases targeting the KDOQI ranges were 18, 50.1 and 54.4%, respectively. The most prevalent biochemical condition was low PTH (62.7%).

CONCLUSION:

PTX prevalence in Italy is stable compared to previous observations, is higher in hemodialysis than in peritoneal dialysis and results in a suboptimal biochemical control.

• Authors: Sandro Mazzaferro, Lida Tartaglione, Carmelo Cascone, Nicola Di Daniele, Antonello Pani, Massimo Morosetti, Marco Francisco, Maurizio Nordio, Maria Leonardi, Mauro Martello, Cristina Grimaldi, Mario Cozzolino, Silverio Rotondi, Marzia Pasquali, Italian Study Group on Mineral Metabolism
• Journal: Journal of nephrology (J Nephrol) Vol. 31 Issue 5 Pg. 767-773 (Oct 2018) ISSN: 1724-6059 [Electronic] Italy
• PMID: 30155676 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Observational Study)

Topics

• Age Factors
• Aged
• Aged, 80 and over
• Humans
• Hyperparathyroidism, Secondary (diagnosis, epidemiology, surgery)
• Italy (epidemiology)
• Middle Aged
• Parathyroidectomy (adverse effects, trends)
• Peritoneal Dialysis (adverse effects, trends)
• Preliminary Data
• Prevalence
• Prospective Studies
• Renal Dialysis (adverse effects, trends)
• Risk Assessment
• Risk Factors
• Sex Factors
• Time Factors
• Treatment Outcome