Parathyroidectomy for dialysis patients in the era of calcimimetics: The surgeons' point of view

Calcimimetics is a new drug for lowering serum parathyroid hormone (PTH), calcium and phosphate in patients with hyperparathyroidism (HPT) on long-term dialysis. It became available on market in 2006. The impact of calcimimetics on the treatment by parathyroidectomy (PTx) was reviewed from the surgeons' point of view. Cure of renal HPT by calcimimetics is not feasible, but calcimimetics can improve preoperative cardiac ventricle ejection fractions by lowering serum PTH. Heart failure is not necessarily a contraindication for PTx. PTx should be done before irreversible organ damage occurs. Limb gangrenes is an ominous sign and should be prevented by frequent checkup for peripheral arterial circulation. The impact of renal osteodystrophy on the quality of life and as indirect cause of mortality deserves more attention in patients with renal HPT. Delayed referral to PTx leads to more complicated patients. A consensus between nephrologists and surgeons about propitious timing for PTx is necessary. Future prospect on the surgical treatment of renal HPT is proposed.

Automated summary

Calcimimetics is a new drug used to lower serum levels of parathyroid hormone, calcium, and phosphate in long-term dialysis patients with hyperparathyroidism. It can improve cardiac function by reducing PTH levels, but does not cure renal HPT. Heart failure is not a contraindication for surgery, and surgery should be performed before irreversible organ damage occurs.