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Horm Metab Res
DOI: 10.1055/a-2309-2240
Original Article: Endocrine Care

Pretransplant Parathyroidectomy in Patients with Severe Secondary Hyperparathyroidism and Long-Term Effectiveness After Kidney Transplantation

Omer Faruk Akcay
1   Nephrology, Gazi University Faculty of Medicine, Ankara, Turkey
,
Haci Hasan Yeter
1   Nephrology, Gazi University Faculty of Medicine, Ankara, Turkey
,
Osman Yuksel
2   General Surgery, Gazi University Faculty of Medicine, Ankara, Turkey
,
Galip Guz
1   Nephrology, Gazi University Faculty of Medicine, Ankara, Turkey
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Abstract

Kidney transplantation (KT) is the best option for patients with end-stage renal disease, but recipients still have legacy bone mineral disease from the pretransplant period, especially patients with severe secondary hyperparathyroidism (sHPT). Patients who had severe sHPT and underwent KT were analyzed retrospectively. Two groups were identified (patients with severe sHPT who had parathyroidectomy or calcimimetic before KT). Bone mineral density (BMD) was measured in the first year and last follow-up at the femoral neck, total hip, and lumbar spine using the dual-energy X-ray absorptiometry (DXA). Persistent hyperparathyroidism (perHPT) incidence was significantly higher in the calcimimetic group (75% vs. 40%, p=0.007). In patients with parathyroidectomy, BMDs were higher at femoral neck (0.818±0.114 vs. 0.744±0.134, p=0.04) and lumbar spine (1.005±0.170 vs. 0.897±0.151, p=0.01) at the first assessment. The BMD comparison between patients treated with parathyroidectomy and calcimimetic found a significant difference only in the femoral neck at second evaluation (0.835±0.118 vs. 0.758±0.129; p=0.03). In multivariate, linear regression revealed a positive association between the last BMD of the femoral neck with body mass index (CC: 0.297, 95% CI, 0.002–0.017) and parathyroidectomy (CC: 0.319, 95% CI, 0.021–0.156). Parathyroidectomy is associated with a significantly better femoral neck BMD and a lower incidence of perHPT in patients with severe sHPT.

Keywords

kidney transplantation - hyperparathyroidism - calcium homeostasis - osteoporosis - parathyroidectomy - body mass index


Publication History

Received: 06 June 2023

Accepted after revision: 13 April 2024

Article published online:
13 May 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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