Surgical and medical treatment of secondary hyperparathyroidism in patients on continuous dialysis.

BACKGROUND: Secondary hyperparathyroidsm (2HPT) is a common complication in hemodialysis patients associated with morbidity and sometimes mortality. The majority of patients with 2HPT can be managed by medical treatment. However, medical treatment does not always provide control of parathyroid disorder. Some patients require surgical treatment, parathyroidectomy (PTx). Successful surgical treatment often results in dramatic drop of the parathyroid hormone (PTH) levels, relieves the patients from clinical symptoms, and reduces mortality. However, at present we do not have reliable evidences showing that PTx.

METHODS: The published papers about medical and surgical treatment for 2HPT within the last 10 years were evaluated to acquire the evidence for the adequate surgical treatments for 2HPT.

RESULTS: Many retrospective, observation studies have confirmed that successful PTx can achieve a dramatic drop of PTH levels, relieve symptoms of 2HPT and reduce mortality. However, we do not have reliable evidence that PTx compared with placebo or active drugs, improves mortality or outcome with respect to cardiovascular symptoms, bone disease, or biochemical parameter. The indications for surgery may be strongly influenced by medical therapy, including treatment with calcimimetics, as well as by composition of the patients material and medical insurance system. There are many treatment of modalities in addition to PTx for dialysis patients with 2HPT. Moreover, we do not have clear evidence telling us which operative procedures is most appropriate for 2HPT, with respect to clinical effectiveness, mortality or risk for recurrence.

CONCLUSION: To acquire the evidence for the adequate medical and surgical treatment for 2HPT including operative procedures, randomized controlled prospective studies are requires.