Prevalence, course and opportunities for correction of secondary hyperparathyroidism in dialysis patients


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Abstract

This review of international and national literature describes immediate and long-term outcomes of parathyroidectomy compared to conservative methods of secondary hyperparathyroidism (SHPT) correction in patients on dialysis. In different health systems optimal approach may vary depending levels of funding. The sensitivity of the parathyroid glands to vitamin D receptor activators and calcimimetic depends largely on the nature hyperplasia - diffuse or nodular. At a certain developmental stage of SHPT, parathyroidectomy may be more clinically effective and cost-effective compared with conservative therapy, providing a full correction of mineral disturbances and bone disease and better survival of dialysis patient. Some uncertainty in the evidence of better survival after parathyroidectomy is associated with the complexity of the study groups formation with comparable other potential risk factors, however, such comparisons, including those held in Russia. Modern techniques of parathyroidectomy include intraoperative parathyroid hormone monitoring, fluorescent intraoperative imaging and preoperative imaging of the gland using ultrasound, computed tomography, and scintigraphy. In cases of SHPT with initial manifestations of resistance to therapy, as an interim solution between conservative therapy and parathyroidectomy, minimally invasive interventions on the parathyroid glands may be applied: sclerotherapy with ethanol or local injection of the active form of vitamin D in the parathyroid glands. The second option differs from sclerotherapy in that the repeated administration of vitamin D provide an enhanced expression of receptors for vitamin D in the gland tissue with subsequent apoptosis under the influence of a local high dose of vitamin d. This eliminates perifocal inflammation inevitable with ethanol sclerotherapy, making possible unconstrained surgical intervention, if necessary in the future.

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