J Korean Surg Soc.  2013 Jul;85(1):25-29.

Achievement of the National Kidney Foundation Kidney Disease Outcomes Quality Initiative: recommended serum calcium, phosphate and parathyroid hormone values with parathyroidectomy in patients with secondary hyperparathyroidism

• Kim WY
• Lee JB
• Kim HY
• Woo SU
• Son GS
• Bae JW

Abstract

PURPOSE
The National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF-K/DOQI) 2003 has established guidelines for the treatment of secondary hyperparathyroidism (SHPT) in patients with chronic kidney disease - minerals and bone disorder (CKD-MBD). This study evaluated parathyroidectomy in SHPT patients for the achievement of the NKF-K/DOQI-recommended values of serum calcium, phosphate, and parathyroid hormone (PTH).
METHODS
Between January 2005 and December 2010, parathyroidectomy was performed as recommended by the NKF-K/DOQI guidelines in 81 patients with SHPT and CKD-MBD. Serum PTH, calcium, and phosphate levels were measured prior to and 6, 12, 36, and 60 months after parathyroidectomy.
RESULTS
Calcium, phosphate, and PTH levels dropped shortly after parathyroidectomy; however, a slight increase showed in the long term. Calcium levels increased for up to 60 months. Phosphate and PTH levels increased for up to 36 months but tended to decrease slightly at 60 months. The mean values were within the target ranges, except for PTH at 36 months. The target parameters of serum phosphate (42.9-61.1% of patients) and serum calcium (a peak of 61.1% of patients at 36 months, but only 28.6% at 60 months) were achieved the most. Less than 34% of patients achieved the recommended range for PTH.
CONCLUSION
Parathyroidectomy was not an optimal procedure for achieving all the biochemical parameters recommended by the NKF-K/DOQI. Although it was helpful in attaining the recommended values for serum calcium and phosphate in SHPT patients resistant to medical therapy, the PTH levels did not fall within the recommended range.

Keyword

Parathyroidectomy; Parathyroid hormone; Calcium; Phosphates

MeSH Terms

Achievement
Calcium
Humans
Hyperparathyroidism, Secondary
Kidney
Kidney Diseases
Minerals
Parathyroid Hormone
Parathyroidectomy
Phosphates
Renal Insufficiency, Chronic
Calcium
Minerals
Parathyroid Hormone
Phosphates

Figure

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  Fig. 1 Percentage of patients with persistent postoperative parathyroid hormone (PTH), calcium (Ca), and phosphate levels within the recommended ranges.

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  Fig. 2 Box-plot graph of parathyroid hormone levels after parathyroidectomy. KDOQI, Kidney Disease Outcomes Quality Initiative.

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  Fig. 3 Box-plot graph of serum calcium levels after parathyroidectomy. KDOQI, Kidney Disease Outcomes Quality Initiative.

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  Fig. 4 Box-plot graph of serum phosphate levels after parathyroidectomy. KDOQI, Kidney Disease Outcomes Quality Initiative.

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