Parathyroidectomy in Endstage Renal Disease

A Pilot Study to Evaluate the Efficacy of Total Parathyroidectomy in Retarding Cardiovascular Calcification in End-stage Renal Disease Patients

To test the hypothesis that total parathyroidectomy retards cardiovascular calcification, improves bone mineral density, reduces cardiac hypertrophy and arterial stiffening in end-stage renal disease patients on maintenance dialysis.

Secondary hyperparathyroidism (SHPT) in patients with end-stage renal disease contributes to increased cardiovascular morbidity and mortality via different mechanisms. Uncontrolled hyperparathyroidism is associated with left ventricular hypertrophy and has been implicated in the development of cardiac interstitial fibrosis and diastolic dysfunction.

Inclusion Criteria:

• Endstage renal disease patients receiving either long-term hemodialysis or peritoneal dialysis treatment, with elevated intact parathyroid hormone (iPTH) levels > 500pg/ml on two or more occasions.
• Patients with parathyroid nodular or diffuse hyperplasia identified by ultrasound imaging or radioisotope scan.
• Patients who provide informed consent for the study.

Exclusion Criteria:

• Patients with significant background valvular heart disease
• Patients who are unfit for general anaesthesia
• Patients with acute myocardial infarction within recent two months
• Patients with poor general condition
• Patients with plans for living related kidney transplant within 1 year
• Patients with previous history of parathyroidectomy
• Patients with calciphylaxis
• Patients with underlying active malignancy
• Patients with contraindication for MRI