Parathyroidectomy as a therapeutic tool for targeting the recommended NKF-K/DOQITM ranges for serum calcium, phosphate and parathyroid hormone in dialysis patients

Abstract

Background. The recommended NKF-K/DOQI'99 ranges for Ca, P and PTH in dialysis seem advisable also for patients previously submitted to parathyroidectomy; however no paper addresses, specifically in this condition, to what extent optimal values are targeted in the short and long term after surgery. Methods. We checked serum Ca, P and PTH basally and after 1 month and 1, 3 and 5 years since surgery, in 77 dialysis subjects who received parathyroidectomy in our hospital. Results. Immediately after surgery all biochemical para- meters dropped, but afterwards Ca showed a tendency to increase progressively in the long term (p <10). Persistence within the ranges (at least on two consecutive checks) was 21 after one month for Ca, with a tendency to reduction; 41 for P, with a tendency to average roughly 30, and practically zero for PTH. Neither type of surgery (total or subtotal) nor vitamin D therapy were associated with the low values of PTH observed. Conclusions. We conclude that parathyroid surgery does not represent an optimal therapeutic tool for targeting the recommended ranges for Ca, P and PTH. In particular, too low PTH values are frequently obtained, whose clinical effects deserve further studies. The possibility of a time dependent risk for recurrence is confirmed. © The Author [2008]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.