Kidney Week

Abstract: PUB567

The Value of Intra-Operative PTH Assay during Parathyroidectomy in Dialysis Patients with Refractory Hyperparathyroidism

Session Information

• Publication Only

Category: Mineral Disease

• 1202 Mineral Disease: Vitamin D, PTH, FGF-23

Authors

• Edon, Adeleye Annick, University of Kentucky, LEXINGTON, Kentucky, United States

Adeleye Annick Edon,

• Wang, Kevin, University of Kentucky, LEXINGTON, Kentucky, United States

Kevin Wang,

• Saxon, David, University of Kentucky, LEXINGTON, Kentucky, United States

David Saxon,

• Lima, Florence, University of Kentucky, LEXINGTON, Kentucky, United States

Florence Lima,

• Sloan, David, University of Kentucky, LEXINGTON, Kentucky, United States

David Sloan,

• Sawaya, B. Peter Emile, University of Kentucky, LEXINGTON, Kentucky, United States

B. Peter Emile Sawaya,

• Mohamed, Amr El-Husseini, University of Kentucky, LEXINGTON, Kentucky, United States

Amr El-Husseini Mohamed,

Background

In dialysis patients with secondary and tertiary hyperparathyroidism (HPT), the correlation of intra-operative parathyroid hormone (ioPTH) measurement during parathyroidectomy (PTX) with long-term PTH level is unknown. The present study aims at evaluating the value of ioPTH measurements on long-term outcome of PTX in dialysis patients in a single center study.

Methods

The ioPTH was measured in 57 hemodialysis patients (33 females and 24 males) who underwent PTX between 2005 and 2015 because of refractory HPT. Near-total PTX was performed in 43 patients, total PTX in 15 patients (one patient underwent second PTX within 3 months because of failure of the first PTX). The ioPTH monitoring included 3 samples: pre-intubation (pre-ioPTH), 10- and 20-minute post PTX (10- ioPTH and 20-ioPTH). The patients were followed for up to 5 years (mean ± SD: 2.2 ± 2.1 years.

Results

The median (25th-75th percentile) pre-, 10- and 20-ioPTH levels were: 1447 pg/ml (969-2168), 143 pg/ml (78-244) and 112 pg/ml (59-153), respectively. There was no significant difference between 20-ioPTH and any subsequent PTH measurements (P=0.8, Figure). Sixteen patients (28%) were readmitted within 90 days due to significant hypocalcemia. One patient was readmitted for post-PTX hematoma evacuation. No patient required repeat PTX because of recurrent HPT.

Conclusion

The 20-ioPTH is a good indicator of long-term PTH values. Hypocalcemia is a common complication and the main reason for readmission after PTX. No patient required second PTX due to recurrent HPT.