Influence of concurrent chronic kidney disease on intraoperative parathyroid hormone monitoring during parathyroidectomy for primary hyperparathyroidism

Abstract

BackgroundThe influence of chronic kidney disease on intraoperative parathyroid hormone monitoring during parathyroidectomy for primary hyperparathyroidism has not been well-established. We hypothesize that chronic kidney disease influences intraoperative parathyroid hormone degradation kinetics during parathyroidectomy. MethodsThis is a single institution retrospective cohort study of consecutive patients with primary hyperparathyroidism underdoing parathyroidectomy. Patients were stratified according to normal kidney function (glomerular filtration rates ≥60 mL/min/1.73 m2 or presence of chronic kidney disease (glomerular filtration rates 15 − 60 mL/min/1.73 m2). Demographics, laboratory data, operative findings, and intraoperative parathyroid hormone data were compared between groups. ResultsOf the 964 study patients, 235 had chronic kidney disease (24.4%), while 729 (75.6%) had normal kidney function. The chronic kidney disease population had a greater median preoperative serum parathyroid hormone (PTH) (125 vs 114 pg/mL; P < .001), but similar median intraoperative parathyroid hormone levels (chronic kidney disease versus normal): baseline (190 vs 189; P = .232), 5 minutes (51 vs 47; P = .667), 10 minutes (37 vs 35; P = .626), and at 15 minutes postexcision (28 vs 27; P = .539). There was no significant difference in the kinetics of the intraoperative parathyroid hormone degradation slope from the baseline to the 15-minute postexcision levels comparing chronic kidney disease with normal kidney function (−21.02 vs −20.83; P = .957). Patients with chronic kidney disease had 15-minute postexcision intraoperative parathyroid hormone levels within the normal range (12 − 65 pg/mL) as frequently as patients with normal kidney function (81% vs 82%; P = .906) and had similar rates of persistent disease (3.4% vs 3.4%; P = .985). ConclusionPatients with chronic kidney disease undergoing parathyroidectomy for primary hyperparathyroidism have similar intraoperative parathyroid hormone degradation kinetics, and the intraoperative parathyroid hormone criteria used to predict cure should be similar to those with normal kidney function.