Abstract
Background
Reduced creatinine clearance is an indication for surgery in asymptomatic primary
hyperparathyroidism, and a significant proportion of patients undergoing parathyroidectomy
have chronic kidney disease. The purpose of this study was to evaluate the kinetics
of intraoperative parathyroid hormone decline during parathyroidectomy in patients
who have chronic kidney disease compared with those with who have normal renal function.
Methods
This is a single-center, retrospective study of patients with primary hyperparathyroidism
undergoing parathyroidectomy (n = 646). Patients were grouped based on estimated glomerular filtration rate greater
than (normal renal function) or less than (chronic kidney disease) 60 mL/min/1.73m2. All patients had intraoperative parathyroid hormone monitoring and ≥6-month postoperative
serum studies to confirm surgical cure. Intraoperative parathyroid hormone kinetic
curves were analyzed using a linear mixed model.
Results
Despite similar pre-excision values, patients with chronic kidney disease had significantly
higher intraoperative parathyroid hormone values at 5 minutes (76 vs 58 pg/mL, P = .02) and 10 minutes (54 vs 37 pg/mL, P = .004) postexcision. No significant difference was observed in whether patients
met Miami criterion by 5 minutes (chronic kidney disease 71%, normal renal function
78%, P = .255) or by 10 minutes (chronic kidney disease 95%, normal renal function 96%,
P = .751) postexcision. Using a linear mixed model, glomerular filtration rate did
not have a significant effect on the change in intraoperative parathyroid hormone
over time.
Conclusion
Patients with chronic kidney disease had significantly higher postexcision intraoperative
parathyroid hormone levels. However, renal function did not affect the change in intraoperative
parathyroid hormone over time, nor did renal function ultimately affect the likelihood
of meeting the Miami criterion. Intraoperative parathyroid hormone monitoring remains
useful in this population, although additional time points may be needed to observe
normalization of values.
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Article info
Publication history
Published online: January 07, 2021
Accepted:
November 18,
2020
Footnotes
Claire E. Graves, MD, and Richard Hwang, MD, are first coauthors.
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
