Abstract: FR-PO0309
Clinical, Laboratory, and Densitometric Outcomes of Parathyroidectomy in the Treatment of Secondary Hyperparathyroidism
Session Information
- CKD-MBD: Mechanistic Insights and Management
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Bone and Mineral Metabolism
- 502 Bone and Mineral Metabolism: Clinical
Authors
- Lopes, Lia Bastos, Hospital das Clinicas da Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
- Gueiros, Ana Paula, Hospital das Clinicas da Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
- Silveira, Andre Albuquerque, Hospital das Clinicas da Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
- Santos, Priscila Florencio, Hospital das Clinicas da Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
- Gueiros, Jose Edevanilson, Hospital das Clinicas da Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
Background
Secondary hyperparathyroidism (SHP) is a severe complication of chronic kidney disease (CKD), and parathyroidectomy (PTX) is indicated for refractory cases. This study assessed the clinical, laboratory, and densitometric parameters before and after PTX in patients undergoing hemodialysis (HD), to assess its effectiveness and benefits.
Methods
The medical records were reviewed of 147 patients who had undergone PTX between June 2015 and December 2025, with follow-up through January 2026. Variables: age, sex, HD duration, CKD etiology, waiting time for PTX, follow-up, clinical manifestations, and bone mineral density. Osteoporosis (OP) was defined as a T score ≤ − 2.5. Laboratory: calcium (Ca), phosphorus (P), intact parathyroid hormone (iPTH), alkaline phosphatase (ALP), albumin (ALB), and 25-hydroxyvitamin D (25OH). Patients with and without OP were compared. Bone mass gain (g/cm2) was assessed in those with pre- and post-PTX densitometry (DXA).
Results
Median age was 43 years, and 50.3% female; CKD etiology was mostly undetermined. HD duration and waiting time for PTX were 120 and 21 months. Total PTX with autotransplantation was performed in 89.8%. Pre-PTX prevalence of pain, fractures, brown tumors, and calciphylaxis was 95.5%, 19.7%, 14.3%, and 2.7%, respectively. After PTX, there was a marked improvement in pain for 99% of patients, and only two patients presented with fractures. Pre-PTX bone DXA was performed in 78 patients, of whom 58% had OP; 46 had follow-up DXA, showing substantial bone mass increases at the femoral neck, total femur, and spine, 18%, 13%, and 19.5%, respectively. At 12 months, compared with preoperative values, Ca, P, ALP, and iPTH (p<0.001 for all) decreased significantly, while ALB (p<0.001) and 25OH (p=0.007) increased. Median follow-up was 20 months, and 85% of patients were alive. Patients with OP presented a higher baseline iPTH and ALP, lower 25OH, in addition to a higher frequency of fractures and brown tumors. Multivariate analysis identified iPTH as an independent risk factor for OP (p=0.01) whereas 25OH was protective (p=0.03).
Conclusion
Our results demonstrate the effectiveness of PTX in the treatment of SHP, leading to improvements in quality of life, nutritional status, and bone mass gain. The severity of SHP, as reflected by elevated iPTH levels, and 25OH deficiency are independent risk factors for OP in HD patients.