Surgical treatment of secondary hyperparathyroidism in chronic hemodialysis

Esqalli. Imane [1a], Knidiri. Hafssa [1b], Chettati .Meriem [1c], Bouzendoufa. Btissam [2a], Fadili.Wafaa [1d], Youssef. Rochdi[2b], Raji.Mohammed [2c], Laouad. Inass [1e]
Page No. 37-43

Introduction: Secondary hyperparathyroidism is a common complication of chronic renal failure.
The surgical management comes after a period of evolution, and it’s recommended particularly
severe and resistant forms to medical treatment. Purpose: The purpose of this work is to clarify the
indication of parathyroidectomy, and assess the folow up of patients.Patient and Methods: This is a
cross-sectional study of 14 patients who are chronic hemodialysis, who were parathyroidectomized
over a period of four years. We analyzed the clinical, biological and radiological parameters
before and after the surgery.Results: The average age of patients at the time of surgery was 47 ± 12
years. The indication for parathyroidectomy was necessary in these 14 patients before resistance to
medical treatment, to achieve the targets of the KDIGO guidelines for calcium, phosphorus and the
PTH1-84 in 10 patients and the persistence of clinical signs of hyperparathyroidism in 4 patients
(bone pain in 3 cases; pathological fractures in one patient). Immediately after surgery, we
have identified an immediate postoperative hypocalcemia in six cases (42.8%). After a mean follow
up of 12 months, we identified the persistence of secondary hyperparathyroidism in two cases
(14.8%). The outcome was favorable in the long term in most cases with a clinical and biological
improvement.Conclusion parathyroidectomy is an effective treatment that stops the overproduction
of parathyroid hormone with good clinical, biological and radiological results. However, the early
treatment of phosphocalcic anomalies with new drugs and the development of renal transplantation
would reduce its prevalence.
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Keywords: parathyroidectomy, hemodialys, hyperparathyroidism