S JONES1, K HEGERTY1,2, C SCUDERI1,2, J EGLINGTON1, B GREEN1, AJ MALLETT1,2
1Royal Brisbane and Womens Hospital, Brisbane
Introduction/Aims: We aimed to assess the practice and outcomes of parathyroidectomy as a treatment for secondary hyperparathyroidism (SHPT) in chronic kidney disease (CKD) in one tertiary Australian centre.
Methods: A retrospective audit of CKD patients with SHPT at a tertiary Australian centre who underwent parathyroidectomy between 1/1/12 and 31/7/17 (n=44) (HREC/17/QRBW/231).
Results: 34 and 11 parathyroidectomies were performed respectively in the 67 months prior to and 11months following the August 2016 delisting of cinacalcet. The median age and body mass index of patients undergoing parathyroidectomy were 51.5years (range 24-79years) and 29 (range 22-55).30/34 patients (88%) were on dialysis. Only 5/34 patients (14%) were treated in accordance with the centre-specific pre-operative protocol detailing medication management to reduce the risk of Hungry Bone Syndrome (HBS). 18/34 patients (53%) were treated as per protocol during the post-operative period.23/34 patients (68%) experienced post-operative complication/s; 52% experienced ≥2 complications. The median length of stay post-parathyroidectomy was 6.5days (range 2-35days) with 32% of patients admitted to the intensive care unit. There was a 23.5% re-admission rate within 28 days of parathyroidectomy. All-cause mortality was 5% at 12months post-parathyroidectomy. A median of 5 outpatient reviews (range 0-37) were required before patients had two consecutive post-operative serum calcium results in normal range whilst on oral therapy. The median follow-up of patients post-parathyroidectomy was 25.5 months.
Conclusions: Parathyroidectomy for SHPT in CKD patients is associated with a significant complication, protocol non-adherence and re-admission rate. There has been an overall increased annual rate of parathyroidectomy for SHPT in CKD patients. Optimised patient selection, protocol review and clinician engagement is indicated to guide the best treatment for our patients.
Nephrology Advanced Trainee Currently Working At Royal Brisbane And Womens Hospital