Comparative analysis of the parathyroidectomy and local vitamin D receptor activator injections into parathyroid glands

AIM: To compare the efficacy of invasive interventions on parathyroid glands: parathyroidectomy (PTE) and local vitamin D injection therapy (LDIT) - in dialysis patients with secondary hyperparathyroidism (SHPT). PATIENTS AND METHODS: The effect size of invasive interventions on laboratory factors of mineral and bone damage CKD in comparison with the continuation of available conservative treatment in matched groups was evaluated for PTE (84 patients in treatment group and 105 - in control) and for LDIT (37 - in treatment group and 62 - in control). The effect size was evaluated for first month after intervention and in comparison between mean values for previous and following year. Treatment and control groups for each intervention were balanced by age, gender, dialysis duration, comorbidity, mineral and bone damage CKD parameters. The baseline PTH levels were 1250±556 pg/ml in PTE group and 921±356 pg/ml in LDIT group. RESULTS: The PTH level decreased by 1075±548 pg/ ml in PTE group. 38% of patients reached target range of PTH level (150-600 pg/ml) during the following year. The PTH level decreased by 347±360 pg/ml in LDIT group. 51% of patients reached target range of PTH level during the following year. The effect size was approximately equal to two pooled standard deviation (SD) of baseline PTH value for PTE and one SD for LDIT and remained stable for following year. The effect size concerning phosphate and alkaline phosphatase was compatible for PTE and LDIT, while concerning calciemia the effect size was significant only for PTE. CONCLUSION: Local vitamin D injection therapy in nodular hyperplasia (calculated gland volume < 0.5 sm3) with moderate PTH elevation (600-1000 pg/ml) are able to retard SHPT progression and improve mineral and bone disease CKD parameters in comparison with continuation of available conservative treatment. The effect size for LDIT is compatible with that for PTE in later stages of hyperplasia.

dialysis, CKD-MBD, hyperparathyroidism, hyperphosphatemia, hypocalciemia, hypercalciemia, parathyroidectomy, local vitamin D injections into parathyroid glands, size effect

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