Intra-operative parathyroid hormone monitoring through central laboratory is accurate in renal secondary hyperparathyroidism

• In secondary hyperparathyroidism (SHPT) the role of intraoperative PTH is debated.
• The criteria of PTH decline predictive of surgical outcome are not standardized.
• The accuracy of a 2nd generation PTH assay by central laboratory was assessed.
• This method is accurate to predict the persistence of SHPT.
• The absolute and % of PTH decline at 30′ were the best predictors of recurrent SHPT.

ObjectiveThe usefulness, the methods and the criteria of intra-operative monitoring of the parathyroid hormone (ioPTH) during parathyroidectomy (PTX) for renal secondary hyperparathyroidism (rSHPT) in patients on chronic hemodialysis remain still matter of debate. The present study aimed to evaluate the ability of a low cost central-laboratory second generation PTH assay to predict an incomplete resection of parathyroid glands (PTG).MethodsThe ioPTH decay was determined In 42 consecutive patients undergoing PTX (15 subtotal and 27 total without auto-transplant of PTG) for rSHPT. The ioPTH monitoring included five samples: pre-intubation, post-manipulation of PTG and at 10, 20 and 30 min post-PTG excision. The patients with PTH exceeding the normal value (65 pg/ml) at the first postoperative week, 6 and 12 months were classified as persistent rSHPT.ResultsThe concentrations of ioPTH declined significantly over time in patients who received total or subtotal PTX; however, no difference was found between the two types of PTX. Irrespective of the type of PTX and the number of PTG removed, combining the absolute and percentage of ioPTH decay at 30 min after PTG excision, we found high sensitivity (100%), specificity (92%), negative predictive value (100%) and accuracy (93%) in predicting the persistence of rSHPT.ConclusionsThe monitoring of the ioPTH decline by a low cost central-laboratory second generation assay is extremely accurate in predicting the persistence of disease in patients on maintenance hemodialysis undergoing surgery for rSHPT.

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