This article appears in the following NDT Plus issue: Parathyroid Intervention - Current themes and future perspectives [View the issue table of contents]
Long-term prognosis of parathyroid function in chronic dialysis patients after PEIT—a single-centre trial
1 Department of Internal Medicine, Tokai University School of Medicine
2 Department of Internal Medicine, Division of Nephrology, Showa University Fujigaoka Hospital
3 Division of Nephrology and Dialysis Center, Kobe University School of Medicine, Japan
Correspondence: Reika Tanaka, Department of Internal Medicine, Tokai University School of Medicine, Bohseidai, Isehara, Kanagawa 259-1193, Japan. Tel: +81-463-93-1121 (Ext. 2350); Fax: +81-463-91-3350; E-mail: kakuta{at}is.icc.u-tokai.ac.jp
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Abstract |
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Background. Secondary hyperparathyroidism (SHPT) is a common complication observed in long-term dialysis patients. Percutaneous ethanol injection therapy (PEIT) of parathyroid glands (PTGs) is now established in Japan as a treatment option for SHPT. In this study, to elucidate the factors influencing efficacy in 1 year and relapse following PEIT, we analysed the long-term prognosis of parathyroid function that is known to have the greatest effect on therapeutic results.
Methods. The study design was a retrospective cohort study. We studied 104 patients with SHPT, who underwent PEIT at Tokai University Hospital between January 1993 and December 2002, and we followed them up until January 2008. The effective group reached intact parathyroid hormone of 200 pg/ml or less, corrected calcium (Ca) of 10.5 mg/dl or less and phosphate (P) of 6.0 mg/dl or less. The ineffective group failed to achieve these criteria.
Results. Among the 104 patients, 66 patients (63%) fulfilled the criteria for the effective group within the first year of PEIT. Using the multivariate logistic regression analysis, the number of PTGs before PEIT was a significant risk factor to deviate from the criteria. At the end of the surveillance period, 31 patients (30%) fulfilled the criteria, and their SHPT was controlled with PEIT. Using the multivariate logistic regression analysis, more than three PTGs at the beginning, and the increase in PTGs during the observation period were significant risk factors to deviate from the criteria. In conclusion, superior results with PEIT are obtained in terms of efficacy, remission period and risk of relapse, regardless of the size of the gland.
Key Words: haemodialysis • long-term prognosis • parathyroid gland • percutaneous ethanol injection therapy • secondary hyperparathyroidism
Received for publication February 29, 2008. Accepted for publication March 7, 2008.