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Project properties

Title	Outcomes after parathyroidectomy in patients with end-stage renal disease related hyperparathyroidism in relation to mineral bone disease markers
Keywords	long-term survival Outcomes Chronic Kidney Disease
Researchers	dr. S. Kruijff W. van der Plas
Nature of the research	Retrospective cohort study
Fields of study	surgery endocrinology nephrology

Background / introduction

Hyperparathyroidism (HPT) is virtually inevitable in chronic kidney disease (CKD) patients requiring long-term dialysis treatment. The optimal management of end-stage renal disease (ESRD)- HPT remains a matter of debate, partly due to lack of evidence. Current Kidney Disease Improving Global Outcomes (KDIGO) CKD – Mineral and Bone Disorder (CKD-MBD) guidelines suggest calcimimetics, calcitriol, and/or vitamin D analogues to lower abnormal PTH levels (level 2B recommendation).1 Parathyroidectomy (PTx) is only advised in patients with severe HPT who fail to respond to medical therapy.1 At what PTH level a patient is considered to have severe HPT, is yet unclear. Despite the absence of scientific evidence, the KDIGO CKD-MBD guidelines recommend to maintain PTH levels within the range of 2-9 times the upper limit of normal.1
PTx has been shown to effectively reduce PTH and serum calcium levels and to improve symptomatology. Several studies have investigated the impact of PTx in dialysis cohorts, observing a significant survival benefit in the PTx groups of 15 – 57% in all-cause mortality.2–7 However, the impact of several pre- and postoperative MBD markers – including serum PTH, calcium and phosphate - on the postoperative survival is unknown. Therefore, the aim of this study is to investigate the outcomes after parathyroidectomy (PTx) in patients with end-stage renal disease (ESRD) related hyperparathyroidism (HPT) in relation to MBD makers.

Research question / problem definition
Primary endpoint will be all-cause mortality according to different PTH ranges. Secondary endpoints will be all-cause and cardiovascular mortality, fracture rate, and cardiovascular disease according to PTH, calcium and phosphate ranges.

Workplan
First, the student will have time to get to know the subject and to read some relevant literature. Than, data collection is required using the electronic patient record system. After that, we will do the statistical analyses together and write the report.

References

1. Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Update Work Group. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention and treatment of chronic kidney disease mineral and bone disorder (CKD-MBD). Kidney Int Suppl. 2017;7:1–59.
2. Kestenbaum B, Andress DL, Schwartz SM, et al. Survival following parathyroidectomy among United States dialysis patients. Kidney Int. 2004;66:2010–6.
3. Komaba H, Taniguchi M, Wada A, et al. Parathyroidectomy and survival among Japanese hemodialysis patients with secondary hyperparathyroidism. Kidney Int. 2015;88:350–9.
4. Goldenstein PT, Elias RM, Pires de Freitas do Carmo L, et al. Parathyroidectomy improves survival in patients with severe hyperparathyroidism: a comparative study. PLoS One. 2013;8:e68870.
5. Ivarsson KM, Akaberi S, Isaksson E, et al. The effect of parathyroidectomy on patient survival in secondary hyperparathyroidism. Nephrol Dial Transplant. 2015;30:2027–33.
6. Sharma J, Raggi P, Kutner N, et al. Improved long-term survival of dialysis patients after near-total parathyroidectomy. J Am Coll Surg. 2012;214:400–7; discussion 407-8.
7. Lau WL, Obi Y, Kalantar-Zadeh K. Parathyroidectomy in the management of secondary hyperparathyroidism. Clinical Journal of the American Society of Nephrology. 2018;13:952–961.

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