Delayed sampling of intraoperative parathormone may be unnecessary during parathyroidectomy in kidney-transplanted and dialysis patients

Andre Albuquerque Silveira, Marilia D'Elboux Guimarães Brescia, Climério Pereira do Nascimento Jr, Sergio Samir Arap, Fabio Luiz de Menezes Montenegro, Andre Albuquerque Silveira, Marilia D'Elboux Guimarães Brescia, Climério Pereira do Nascimento Jr, Sergio Samir Arap, Fabio Luiz de Menezes Montenegro

Abstract

Introduction: Some authors advise in favor of delayed sampling of intraoperative parathormone testing (ioPTH) during parathyroidectomy in dialysis and kidney-transplanted patients. The aim of the present study was to evaluate the intensity and the role of delayed sampling in the interpretation of ioPTH during parathyroidectomy in dialysis patients (2HPT) and successful kidney-transplanted patients (3HPT) compared to those in single parathyroid adenoma patients (1HPT).

Methods: This was a retrospective study of ioPTH profiles in patients with 1HPT, 2HPT, and 3HPT operated on in a single institution. Samples were taken at baseline ioPTH (sampling at the beginning of the operation), ioPTH-10 min (10 minutes after excision of the parathyroid glands), and ioPTH-15 min (15 minutes after excision of the parathyroid glands). The values were compared to baseline.

Results: Median percentage values of ioPTH compared to baseline (100%) were as follows: 1HPT, ioPTH-10 min = 20% and ioPTH-15 min = 16%; 2HPT, ioPTH-10 min = 14% and ioPTH-15 min = 12%; 3HPT, ioPTH-10 min = 18% and ioPTH-15 min = 15%.

Discussion: The reduction was equally effective at 10 minutes in all groups. In successful cases, ioPTH decreases satisfactorily 10 minutes after parathyroid glands excision in dialysis and transplanted patients, despite significant differences in kidney function. The postponed sampling of ioPTH appears to be unnecessary.

Trial registration: ClinicalTrials.gov NCT02464072.

Conflict of interest statement

Conflict of interest

The authors declare that they have no conflict of interest.

Figures

Figure 1. Mean and standard deviation of…
Figure 1. Mean and standard deviation of relative values of intraoperative parathormone (ioPTH) compared to baseline after successful parathyroidectomy in single parathyroid adenoma (1HPT), 2HPT (secondary hyperparathyroidism in dialytic patient), and 3HPT (persistent hyperparathyroidism after kidney transplant).

References

    1. Block GA, Klassen PS, Lazarus JM, Ofsthun N, Lowrie EG, Chertow GM. Mineral metabolism, mortality, and morbidity in maintenance hemodialysis. J Am Soc Nephrol. 2004 Aug;15(8):2208–2218.
    1. Goldenstein PT, Elias RM, Carmo LPF, Coelho FO, Magalhães LP, Antunes GL. Parathyroidectomy improves survival in patients with severe hyperparathyroidism: a comparative study. PLoS One. 2013 Aug;8(8):e68870.
    1. Costa-Hong V, Jorgetti V, Gowdak LH, Moyses RMA, Krieger EM, Lima JJG. Parathyroidectomy reduces cardiovascular events and mortality in renal hyperparathyroidism. Surgery. 2007 Nov;142(5):699–703.
    1. Komaba H, Taniguchi M, Wada A, Iseki K, Tsubakihara Y, Fukagawa M. Parathyroidectomy and survival among Japanese hemodialysis patients with secondary hyperparathyroidism. Kidney Int. 2015 Aug;88(2):350–359.
    1. Van Der Plas WY, Dulfer RR, Engelsman AF, Vogt L, Borst MH, Van Ginhoven TM, et al. Effect of parathyroidectomy and cinacalcet on quality of life in patients with end-stage renal disease-related hyperparathyroidism: a systematic review. Nephrol Dial Transplant. 2017 Nov;32(11):1902–1908.
    1. Bratucu MN, Garofil ND, Radu PA, Paic V, Goleanu V, Zurzu M, et al. Measurement of quality of life after total parathyroidectomy in patients with secondary hyperparathyroidism and end stage renal disease. Chirurgia (Bucur) 2015 Nov-Dec;110(6):511–517.
    1. Alves W, Filho, Van Der Plas WY, Brescia MDG, Nascimento CP, Junior, Goldestein P, Massoni LM, Neto, et al. Quality of life after surgery in secondary hyperparathyroidism, comparing subtotal parathyroidectomy with total parathyroidectomy with immediate parathyroid autograft: prospective randomized trial. Surgery. 2018 Nov;164(5):978–985.
    1. Triponez F, Clark OH, Vanrenthergem Y, Evenepoel P. Surgical treatment of persistent hyperparathyroidism after renal transplantation. Ann Surg. 2008 Jul;248(1):18–30.
    1. Irvin GL, Solorzano CC, Carneiro DM. Quick intraoperative parathyroid hormone assay: surgical adjunct to allow limited parathyroidectomy, improve success rate, and predict outcome. World J Surg. 2004 Dec;28(12):1287–1292.
    1. Richards ML, Thompson GB, Farley DR, Grant CS. An optimal algorithm for intraoperative parathyroid hormone monitoring. Arch Surg. 2011 Mar;146(3):280–285.
    1. Montenegro FLMBL, Nascimento CP. Supernumerary parathyroid glands in secondary hyperparathyroidism. Rev Bras Cir Cabeca Pescoço. 2009;38:153–156.
    1. Ohe MN, Santos RO, Kunii IS, Carvalho AB, Abrahão M, Neves MC, Lazaretti-Castro M. Intraoperative PTH cutoff definition to predict successful parathyroidectomy in secondary and tertiary hyperparathyroidism. Braz J Otorhinolaryngol. 2013 Aug;79(4):494–499.
    1. Lokey J, Pattou F, Mondragon-Sanchez A, Minuto M, Mullineris B, Wambergue F. Intraoperative decay profile of intact (1-84) parathyroid hormone in surgery for renal hyperparathyroidism--a consecutive series of 80 patients. Surgery. 2000 Dec;128(6):1029–1034.
    1. Vulpio C, Bossola M, Di Stasio E, Pepe E, Magalini S, Agnes S. Intra-operative parathyroid hormone monitoring through central laboratory is accurate in renal secondary hyperparathyroidism. Clin Biochem. 2016 May;49(7-8):538–543.
    1. Numano M, Tominaga Y, Uchida K, Orihara A, Tanaka Y, Takagi H. Surgical significance of supernumerary parathyroid glands in renal hyperparathyroidism. World J Surg. 1998 Oct;22(10):1098–1102. discussion:1103.
    1. Vieira JGH, Kunii IS, Ohe MN, Carvalho AB. Heterogeneity of carboxyl-terminal parathyroid hormone circulating forms in patients with hyperparathyroidism due to end stage renal disease. Arq Bras Endocrinol Metabol. 2009 Dec;53(9):1074–1078.
    1. Kidney Disease: Improving Global Outcomes KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD) Kidney Int Suppl. 2009;76(Suppl 113):S1–130.
    1. Edwards CM, Folek J, Dayawansa S, Govednik CM, Quinn CE, Sigmond BR. Central venous parathyroid hormone monitoring using a novel, specific anatomic method accurately predicts cure during minimally invasive parathyroidectomy. Am J Surg. 2016 Dec;212(6):1154–1161.
    1. Komaba H, Moriwaki K, Goto S, Yamada S, Taniguchi M, Kakuta T. Cost-effectiveness of cinacalcet hydrochloride for hemodialysis patients with severe secondary hyperparathyroidism in Japan. Am J Kidney Dis. 2012 Aug;60(2):262–271.
    1. National Kidney Foundation K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis. 2003 Oct;42(Suppl 3):S1–S201.
    1. Zhang L, Xing C, Shen C, Zeng M, Yang G, Mao H. Diagnostic accuracy study of intraoperative and perioperative serum intact PTH level for successful parathyroidectomy in 501 secondary hyperparathyroidism patients. Sci Rep. 2016 May;6:26841–26841.
    1. Irvin GL, Dembrow VD, Prudhomme DL. Clinical usefulness of an intraoperative "quick parathyroid hormone" assay. Surgery. 1993 Dec;114(6):1019–1023.
    1. Carneiro DM, Solorzano CC, Nader MC, Ramirez M, Irven GL. Comparison of intraoperative iPTH assay (QPTH) criteria in guiding parathyroidectomy: which criterion is the most accurate? Surgery. 2003 Dec;134(6):973–979. discussion:979-81.
    1. Egan RJ, Iliff H, Stechman MJ, Scott-Coombes DM. Intraoperative parathyroid hormone assay remains predictive of cure in renal impairment in patients with single parathyroid adenomas. World J Surg. 2018 Sep;42(9):2835–2839.
    1. Yamashita H, Gao P, Noguchi S, Cantor T, Uchino S, Watanabe S. Role of cyclase activating parathyroid hormone (1-84 PTH) measurements during parathyroid surgery: potential improvement of intraoperative PTH assay. Ann Surg. 2002 Jul;236(1):105–111.
    1. Kim WY, Lee JB, Kim HY. Efficacy of intraoperative parathyroid hormone monitoring to predict success of parathyroidectomy for secondary hyperparathyroidism. J Korean Surg Soc. 2012 Jul;83(1):1–6.
    1. Seehofer D, Rayes N, Klupp J. Predictive value of intact parathyroid hormone measurement during surgery for renal hyperparathyroidism. Langenbecks Arch Surg. 2005;390:222–229.
    1. Matsuoka S, Tominaga Y, Sato T, Uno N, Goto N, Katayama A. QuiCk-intraoperative bio-intact PTH assay at parathyroidectomy for secondary hyperparathyroidism. World J Surg. 2007 Apr;31(4):824–831.
    1. Chou FF, Lee CH, Chen JB, Hsu KT, Sheen-Chen SM. Intraoperative parathyroid hormone measurement in patients with secondary hyperparathyroidism. Arch Surg. 2002 Mar;137(3):341–344.
    1. Bieglmayer C, Kaczirek K, Prager G, Niederle B. Parathyroid hormone monitoring during total parathyroidectomy for renal hyperparathyroidism: pilot study of the impact of renal function and assay specificity. Clin Chem. 2006 Jun;52(6):1112–1119.

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