Abstracts - Orals, Featured Poster Presentations, and Posters
SUN 234-256-Bone & Calcium Metabolism: Clinical Trials & Case Series
Expo Halls ABC (Moscone Center)
Poster Board SUN-252
: Compare the effective treatment of calcitriol regimens (loaded and titrated) in the control hypocalcimic hyperparathyroid (HPT) patients who were referred for parathyroidectomy.
Method: Randomized control, open labeled study of twenty-five patients who underwent parathyroidectomy in Rajavithi hospital during August 2009 to September 2010 was performed. We randomized patients in two treatment arms of calcitriol (A; Titrated dose regimen, B; Loaded dose regimen), 25 patients of chronic kidney disease patients that meet criteria. Biochemical factors available within 2 weeks before and after surgery were recorded and analysed.
Result: No significant different in amount of calcium gluconate intravenous use, hypocalcemia and hospital admission durations between titrated and loaded regimen by p=0.1, 0.63 and 0.46 respectively. Loaded regimen ameliorated the mean reduction of day 7 post- operative serum calcium level (0.33±0.99) compared to titrate regimen patients (2.68±2.16, p=0.036).
Conclusion: Loaded calcitriol regimen superior than titrated calcitriol regimen in controlled the first 7 days calcium level of postparathyroidectomy but amount of calcium gluconate intravenous used, hypocalcemia event and duration of hospital stay did not showed any different.
Keywords: Parathyroidectomy, Hyperparathyroidism, Hypocalcemia and Calcitriol
1. Cozzolino M, Gallieni M, Corsi C et al (2004) Management of calcium refilling post-parathyroidectomy in end-stage renal disease. J Nephrol 17:3–8 2. Sitges-Serra A, Caralps-Riera A (1987) Hyperparathyroidism associated with renal disease: pathogenesis, natural history, and surgical treatment. Surg Clin North Am 67:359–377 3. Jofre R, Lopez Gomez JM, Menarguez J et al (2003) Parathyroidectomy: whom and when? Kidney Int Suppl 85:S97–S100 4. Yajima A, Ogawa Y, Takahashi HE et al (2003) Changes of bone remodeling immediately after parathyroidectomy for secondary hyperparathyroidism. Am J Kidney Dis 42:729–738 5. Cruz DN, Perazella MA (1997) Biochemical aberrations in a dialysis patient following parathyroidectomy. Am J Kidney Dis 29:759–762 6. Viaene L, Evenepoel P, Bammens B, Claes K, Kuypers D, Vanrenterghem Y. Nephron Clin Pract. 2008;110(2):c80-5. Epub 2008 Sep 1 7. Albright F, Reifenstein EC (1948) The parathyroid glands and metabolic bone disease: selected studies. Williams & Wilkins, Baltimore 8. Mazzaferro S, Chicca S, Pasquali M, Zaraca F, Ballanti P, Taggi F, Coen G, Cinotti GA, Carboni M.Nephrol Dial Transplant. 2000 Jun;15(6):877-82 9. National Kidney Foundation (2003) K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis 42:S1–S201 10. Kinnaert P, Tielemans C, Dhaene M et al (1998) Evaluation of surgical treatment of renal hyperparathyroidism by measuring intact parathormone blood levels on first postoperative day. World J Surg 22:695–699 11. Koonsman M, Hughes K, Dickerman R et al (1994) Parathyroidectomy in chronic renal failure. Am J Surg 168:631–635 12. Clair F, Leenhardt L, Bourdeau A et al (1987) Effect of calcitriol in the control of plasma calcium after parathyroidectomy: a placebo-controlled, double-blind study in chronic hemodialysis patients. Nephron 46:18–22 13. Demeure MJ, McGee DC, Wilkes W et al (1990) Results of surgical treatment for hyperparathyroidism associated with renal disease. Am J Surg 160:337–340 14. Nakagawa M, Emoto A, Nasu N et al (2000) Calcium supplement necessary to correct hypocalcemia after total parathyroidectomy for renal osteodystrophy. Int J Urol 7:35–40 15. Delmonico FL, Wang CA, Rubin NT et al (1984) Parathyroid surgery in patients with renal failure. Ann Surg 200:644–647 16. Felsenfeld AJ, Gutman RA, Llach F et al (1984) Postparathyroidectomy hypocalcemia as an accurate indicator of preparathyroidectomy bone histology in the uremic patient. Miner Electrolyte Metab 10:166–172 17. Chandran PK, Ulahannan TJ, Skiles M (1993) Biochemical changes following parathyroidectomy. Int J Artif Organs 16:700–703 18. Brasier AR, Nussbaum SR (1988) Hungry bone syndrome: clinical and biochemical predictors of its occurrence after parathyroid surgery. Am J Med 84:654–660 19. Schomig M, Ritz E (2000) Management of disturbed calcium metabolism in uraemic patients. 2. Indications for parathyroidectomy. Nephrol Dial Transplant 15(suppl 5):25–29
Nothing to Disclose: SN, CD, CS, BLN, UK, PA
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