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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 PLoS+One
2017 ; 12
(11
): e0187025
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gab.com Text
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Impact of surgical parathyroidectomy on chronic kidney disease-mineral and bone
disorder (CKD-MBD) - A systematic review and meta-analysis
#MMPMID29107998
Apetrii M
; Goldsmith D
; Nistor I
; Siriopol D
; Voroneanu L
; Scripcariu D
; Vervloet M
; Covic A
PLoS One
2017[]; 12
(11
): e0187025
PMID29107998
show ga
For more than 6 decades, many patients with advanced chronic kidney disease (CKD)
have undergone surgical parathyroidectomy (sPTX) for severe secondary
hyperparathyroidism (SHPT) mainly based historical clinical practice patterns,
but not on evidence of outcome.We aimed in this meta-analysis to evaluate the
benefits and harms of sPTX in patients with SHPT. We searched MEDLINE (inception
to October 2016), EMBASE and Cochrane Library (through Issue 10 of 12, October
2016) and website clinicaltrials.gov (October 2016) without language restriction.
Eligible studies evaluated patients reduced glomerular filtration rate (GFR),
below 60 mL/min/1.73 m2 (CKD 3-5 stages) with hyperparathyroidism who underwent
sPTX. Reviewers working independently and in duplicate extracted data and
assessed the risk of bias. The final analysis included 15 cohort studies,
comprising 24,048 participants. Compared with standard treatment, sPTX
significantly decreased all-cause mortality (RR 0.74 [95% CI, 0.66 to 0.83]) in
End Stage Kidney Disease (ESKD) patients with biochemical and / or clinical
evidence of SHPT. sPTX was also associated with decreased cardiovascular
mortality (RR 0.59 [95% CI, 0.46 to 0.76]) in 6 observational studies that
included almost 10,000 patients. The available evidence, mostly observational, is
at moderate risk of bias, and limited by indirect comparisons and inconsistency
in reporting for some outcomes (eg. short term adverse events, including
documented voice change or episodes of severe hypocalcaemia needing admission or
long-term adverse events, including undetectable PTH levels, risk of fractures
etc.). Taken together, the results of this meta-analysis would suggest a
clinically significant beneficial effect of sPTX on all-cause and cardiovascular
mortality in CKD patients with SHPT. However, given the observational nature of
the included studies, the case for a properly conducted, independent randomised
controlled trial comparing surgery with medical therapy and featuring many
different outcomes from mortality to quality of life (QoL) is now very strong.
|Cause of Death
[MESH]
|Chronic Kidney Disease-Mineral and Bone Disorder/*etiology/mortality
[MESH]