Pharmacotherapeutic and laboratory profile analysis of patients with secondary hyperparathyroidism submitted to parathyroidectomy
DOI:
https://doi.org/10.33448/rsd-v11i5.27949Keywords:
Secondary hyperparathyroidism; Chronic kidney disease; Pharmacotherapy; Surgical intervention.Abstract
This study aimed to analyze the pharmacotherapeutic and laboratory profile of patients with secondary hyperparathyroidism submitted to Parathyroidectomy and followed up at the nephrology outpatient clinic of a University Hospital. This is a descriptive, cross-sectional, retrospective and quantitative study, collecting data from January 2003 to January 2020, carried out at the Nephrology outpatient clinic of the Hospital das Clínicas of the Federal University of Pernambuco (HC/UFPE), in the city of Recife - PE. The collected data were tabulated in an electronic spreadsheet. For the descriptive analysis of the collected data, measures of frequency, mean, standard deviation and mode were used. The study included 91 patients, whose mean age was 48.1 years (± 12.4) and the majority was greater than or equal to 59 years (82.4%), female (68,1%), self-declared black/ brown (90.1%), single (49.5%), with incomplete primary education (24.2%) and residing in rural areas (87.9%). The diagnosis of undetermined etiology had the highest prevalence (41.8%). Most had disease prior to CKD (56.0%) and were not submitted to conservative treatment (76.9%). Laboratory parameters varied over the follow-up period. The main drugs used by patients were calcium carbonate 500mg (100%); calcitriol 0.25mcg (96.7%); sevelamer 800mg (85.7%); and cinacalcete 30mg (21.9%). The multifaceted approach remains at the forefront of treatment, with no single intervention measure being considered superior. Parathyroidectomy remains a valid treatment option for patients who are refractory to drug therapy and should continue to be considered whenever there is a medical indication.
References
Agarwal, R., & Georgianos, P. I. (2016). Con: Nutritional vitamin D replacement in chronic kidney disease and end-stage renal disease. Nephrology Dialysis Transplantation, 31 (5), 706–713. doi: 10.1093/ndt/gfw080.
Barroso, W. K. S., Rodrigues, C. I. S., Bortolotto, L. A., Mota-Gomes, M. A., Brandão, A. A., Feitosa, A. D. de M. ... & Póvoa, R. M. dos S. (2021). Diretrizes Brasileiras de Hipertensão Arterial – 2020. Arq. Bras. Cardiol., 116 (3), 516–658. doi: 10.36660/abc.20201238.
Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Comissão Nacional de Incorporação de Tecnologias no Sistema Único de Saúde (2017). Protocolo Clínico e Diretrizes Terapêuticas do Distúrbio Mineral Ósseo na Doença Renal Crônica. Brasília: Ministério da Saúde.
Brasil. Ministério da Saúde. Secretaria de Ciência, Tecnologia e Insumos Estratégicos. Departamento de Gestão e Incorporação de Tecnologias em Saúde (2015). Cinacalcete para tratamento de pacientes com hiperparatireoidismo secundário à doença renal, em diálise e refratários à terapia convencional. Brasília: Ministério da Saúde.
Bravo-Zúñiga, J., Gálvez-Inga, J., Carrillo-Onofre, P., Chávez-Gómez, R., & Castro-Monteverde, P. (2019). Early detection of chronic renal disease: coordinated work between primary and specialized care in an ambulatory renal network of Peru. Brazilian Journal of Nephrology, 41 (2), 176–184. doi: 10.1590/2175-8239-jbn-2018-0101.
Bucharles, S. G. E., Barreto, F. C., & Riella, M. C. (2019). Impacto de cinacalcete em marcadores do metabolismo mineral de pacientes em diálise portadores de hiperparatireoidismo secundário grave. Brazilian Journal of Nephrology, 41, 336-344. doi: 10.1590/2175-8239-JBN-2018-0219.
Chen, L., Wang, K., Yu, S., Lai, L., Zhang, X., Yuan, J., & Duan, W. (2016). Long–term mortality after parathyroidectomy among chronic kidney disease patients with secondary hyperparathyroidism: a systematic review and meta-analysis. Renal Failure, 38 (7), 1050–1058. doi: 10.1080/0886022x.2016.1184924.
Custódio, M. R., Canziani, M. E. F., Moysés, R. M. A., Barreto, F. C., Neves, C. L., Oliveira, R. B. D. ... & Carvalho, A. B. D. (2013). Clinical protocol and therapeutic guidelines for the treatment of secondary hyperparathyroidism in patients with chronic kidney disease. Brazilian Journal of Nephrology, 35 (4), 308-322. doi: 10.5935/0101-2800.20130050.
Drüeke, T. B., & Massy, Z. A. (2016). Changing bone patterns with progression of chronic kidney disease. Kidney International, 89 (2), 289–302. doi: 10.1016/j.kint.2015.12.004.
Dumont, L. S., Manata, I. C., Oliveira, V. A. C. D., Acioli, M. L. B., Pina, G. C., Real, L. L. C. & Macedo, R. G. (2021). Doença renal crônica: doença subdiagnosticada? Análise epidemiológica em um centro de diálise. Research, Society and Development, 10 (14), e523101422278. doi: 10.33448/rsd-v10i14.22278.
Estrela, C. (2018). Metodologia científica: ciência, ensino e pesquisa (pp: 179-181). São Paulo: Artes Médicas.
Fang, L., Wu, J., Luo, J., Wen, P., Xiong, M., Cao, J. … & Yang, J. (2018). Changes in bone mineral density after total parathyroidectomy without autotransplantation in the end-stage renal disease patients with secondary hyperparathyroidism. BMC Nephrology, 19 (1). doi: 10.1186/s12882-018-0934-1.
Fernandes, D., Zanelli, T. L. P., Rodrigues, A. S., Rodrigues, M. P., Lodi, J. C., Marques, T. M. ... & Milagres, C. S. (2020). Qualidade de vida de pacientes em terapia renal substitutiva: uma análise da doença renal crônica e perfil populacional de risco. Revista Eletrônica Acervo Saúde, 12 (12), e4759. doi: 10.25248/reas.e4759.2020.
Fouque, D., Roth, H., Darné, B., Jean-Bouchet, L., Daugas, E., Drüeke, T. B. … & London, G. M. (2017). Achievement of Kidney Disease: Improving Global Outcomes mineral and bone targets between 2010 and 2014 in incident dialysis patients in France: the Photo-Graphe3 study. Clinical Kidney Journal, 11 (1), 73–79. doi: 10.1093/ckj/sfx101.
Garabed, E., Norbert, L., & Bertram, L. K. (2017). Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Update Work Group. KDIGO 2017 Clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease–mineral and bone disorder (CKD-MBD). Kidney International Supplement, 7 (1), 1-59.
Gerbino, A., & Colella, M. (2018). The different facets of extracellular calcium sensors: old and new concepts in calcium-sensing receptor signalling and pharmacology. International journal of molecular sciences, 19 (4), 999. doi: 10.3390/ijms19040999.
Hawley, C. M., & Holt, S. G. (2017). Parathyroid hormone targets in chronic kidney disease and managing severe hyperparathyroidism. Nephrology, 22, 47–50. doi: 10.1111/nep.13029.
Hedgeman, E., Lipworth, L., Lowe, K., Saran, R., Do, T., & Fryzek, J. (2015). International Burden of Chronic Kidney Disease and Secondary Hyperparathyroidism: A Systematic Review of the Literature and Available Data. International Journal of Nephrology, 2015, 1–15. doi: 10.1155/2015/184321.
Jain, N., & Reilly, R. F. (2017). Hungry bone syndrome. Current Opinion in Nephrology and Hypertension, 26 (4), 250–255. doi: 10.1097/mnh.0000000000000327.
Ketteler, M., Block, G. A., Evenepoel, P., Fukagawa, M., Herzog, C. A., McCann, L., ... & Leonard, M. B. (2017). Executive summary of the 2017 KDIGO Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD) Guideline Update: what’s changed and why it matters. Kidney International, 92 (6), 26–36. doi: 10.1016/j.kint.2017.04.006.
KGIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease (2017). Nephrology and Dialysis, 19 (1), 22–206. doi: 10.28996/1680-4422-2017-1-22-206.
Komaba, H., Ketteler, M., Cunningham, J., & Fukagawa, M. (2021). Old and New Drugs for the Management of Bone Disorders in CKD. Calcified Tissue International, 108 (4), 486–495. doi: 10.1007/s00223-020-00788-y.
Kruijff, S., Van der Plas, W. Y., Dulfer, R. R., Vriens, M. R., van Ginhoven, T. M., Engelsman, A. F., & Delbridge, L. W. (2019). Changing landscape of the treatment of hyperparathyroidism related to end-stage renal disease - can we turn the clock backward? Surgery, 165 (2), 289–290. doi: 10.1016/j.surg.2018.07.043.
Lau, W. L., Obi, Y., & Kalantar-Zadeh, K. (2018). Parathyroidectomy in the Management of Secondary Hyperparathyroidism. Clinical Journal of the American Society of Nephrology, 13 (6), 952–961. doi: 10.2215/CJN.10390917.
Lorenz, K., Bartsch, D. K., Sancho, J. J., Guigard, S., & Triponez, F. (2015). Surgical management of secondary hyperparathyroidism in chronic kidney disease - a consensus report of the European Society of Endocrine Surgeons. Langenbeck’s Archives of Surgery, 400 (8), 907–927. doi: 10.1007/s00423-015-1344-5.
Lu, K.-C., Ma, W.-Y., Yu, J.-C., Wu, C.-C., & Chu, P. (2012). Bone turnover markers predict changes in bone mineral density after parathyroidectomy in patients with renal hyperparathyroidism. Clinical Endocrinology, 76 (5), 634–642. doi: doi.org/10.1111/j.1365-2265.2011.04265.x.
Marinho, A. W. G. B., Penha, A. da P., Silva, M. T., & Galvão, T. F. (2017). Prevalência de doença renal crônica em adultos no Brasil: revisão sistemática da literatura. Cadernos Saúde Coletiva, 25 (3), 379–388. doi: 10.1590/1414-462x201700030134.
Maruyama, Y., Taniguchi, M., Kazama, J. J., Yokoyama, K., Hosoya, T., Yokoo, T. … & Tsubakihara, Y. (2014). A higher serum alkaline phosphatase is associated with the incidence of hip fracture and mortality among patients receiving hemodialysis in Japan. Nephrology Dialysis Transplantation, 29 (8), 1532–1538. doi: 10.1093/ndt/gfu055.
Naves-Diaz, M., Passlick-Deetjen, J., Guinsburg, A., Marelli, C., Fernandez-Martin, J. L., Rodriguez-Puyol, D., & Cannata-Andia, J. B. (2010). Calcium, phosphorus, PTH and death rates in a large sample of dialysis patients from Latin America. The CORES Study. Nephrology Dialysis Transplantation, 26 (6), 1938–1947. doi: 10.1093/ndt/gfq304.
Neves, P. D. M. de M., Sesso, R. de C. C., Thomé, F. S., Lugon, J. R., & Nascimento, M. M. (2020). Censo Brasileiro de Diálise: análise de dados da década 2009-2018. J. Bras Nefrol., 42 (2), 191–200. doi: 10.1590/2175-8239-JBN-2019-0234.
Oliveira, R. B. de, Silva, E. N. da, Charpinel, D. M. F., Gueiros, J. E. B., Neves, C. L., Sampaio, E. de A. ... & Carvalho, A. B. de. (2011). Situação do hiperparatireoidismo secundário autônomo no Brasil: dados do censo brasileiro de paratireoidectomia. Jornal Brasileiro de Nefrologia, 33 (4), 457–462. doi: 10.1590/s0101-28002011000400011.
Porto, R. A., Truite, M. R., Bucharles, S. E., & Hauser, A. B. (2016). Hiperparatireoidismo secundário: uma complicação da Doença Renal Crônica. Rev. Bras. Anal. Clin, 48 (3), 182-188.
Rodríguez-Ortiz, M. E., & Rodríguez, M. (2020). Recent advances in understanding and managing secondary hyperparathyroidism in chronic kidney disease. F1000Research, 9, 1077. doi: 10.12688/f1000research.22636.1.
Ruppel, P., Felipe, C. R., Medina-Pestana, J. O., Hiramoto, L. L., Viana, L., Ferreira, A. ... & Tedesco-Silva Jr, H. (2018). A influência de fatores clínicos, ambientais e socioeconômicos na sobrevida de cinco anos após o transplante renal. Brazilian Journal of Nephrology, 40, 151–161. doi: 10.1590/2175-8239-JBN-3865.
Sampaio, E. de A., & Moysés, R. M. A. (2011). Paratireoidectomia na DRC. Jornal Brasileiro de Nefrologia, 33 (2), 189–247. doi: 10.1590/s0101-28002011000200018.
Van Der Plas, W. Y., Dulfer, R. R., Engelsman, A. F., Vogt, L., De Borst, M. H., van Ginhoven, T. M., ... & Dutch (2017). Effect of parathyroidectomy and cinacalcet on quality of life in patients with end-stage renal disease-related hyperparathyroidism: a systematic review. Nephrology Dialysis Transplantation, 32 (11), 1902-1908. doi: 10.1093/ndt/gfx044.
Wan, J., Li, W., & Zhong, Y. (2018). Parathyroidectomy decreases serum intact parathyroid hormone and calcium levels and prolongs overall survival in elderly hemodialysis patients with severe secondary hyperparathyroidism. Journal of Clinical Laboratory Analysis, 33 (3), e22696. doi: 10.1002/jcla.22696.
Webster, A. C., Nagler, E. V., Morton, R. L., & Masson, P. (2017). Chronic Kidney Disease. The Lancet, 389 (10075), 1238–1252. doi: 10.1016/s0140-6736(16)32064-5.
Wolf, M. (2012). Update on fibroblast growth factor 23 in chronic kidney disease. Kidney International, 82 (7), 737–747. doi: 10.1038/ki.2012.176.
Zhang, Y., Lu, Y., Feng, S., Zhan, Z., & Shen, H. (2019). Evaluation of laboratory parameters and symptoms after parathyroidectomy in dialysis patients with secondary hyperparathyroidism. Renal Failure, 41 (1), 921–929. doi: 10.1080/0886022x.2019.1666724.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2022 Anderson Pereira de Oliveira; Francisca Sueli Monte Moreira; Regina Meira Lima de Souza; Jane Sheila Higino; Isabela da Silva Barbosa; Beatriz Dayane Silva de Oliveira; Rayane Karine Santos Menino; Celuane Alves Moura
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.