Comparative Study between Parathyroidectomy and Medical Treatment for Hemodialysis Patients with Secondary Hyperparathyroidism and their Effect on Anemia

Background: One of the most significant complications of chronic renal disease is secondary hyperparathyroidism (SHPT).It is still a debate to determine the treatment regimens of SHPT for every particular patient and the parameters used for follow-up.
Objective: This study aimed tocompare parathyroidectomy and medical treatment of SHPT in hemodialysis patients to determine which line of treatment is more effective and to assess the effect of treatment on anemia.
Patients and methods: This cohort retrospective study included 60 patients of end stage renal disease (ESRD) on regular hemodialysis above the age of 18 years old, of both sexes, with duration of hemodialysis more than one year, duration of treatment more than 6 months and intact parathyroid hormone (iPTH) more than 800 pg/ml. Patients were classified into three equal groups: Group 1 (parathyroidectomy group), group 2 who were on cinacalcet medical treatment and group 3 who were on conventional medical treatment vitamin D analogues.
Results:  In 12 months- post- management, there were comparable findings between the groups at calcium levels. However, phosphorus, iPTH and alkaline phosphatase levels were substantially elevated in vit D analogues group and lower in parathyroidectomy group. Hemoglobin levels were substantially elevated in both parathyroidectomy and cinacalcet groups when compared with vit D analogues group at 12 months post-management.
Conclusions:  Parathyroidectomy is more effective than medical treatment for hemodialysis patients with SHPT.