Pharmaceutical Management of Secondary Hyperparathyroidism and the Role of Surgery: A 5-Year Retrospective Study

Christina Sevva; Dimitrios Divanis; Ariti Tsinari; Petros Grammenos; Styliani Laskou; Stylianos Mantalobas; Eleni Paschou; Vasiliki Magra; Periklis Kopsidas; Isaak Kesisoglou; Vassilios Liakopoulos; Konstantinos Sapalidis

doi:10.3390/medicina60050812

Medicina (May 2024)

Pharmaceutical Management of Secondary Hyperparathyroidism and the Role of Surgery: A 5-Year Retrospective Study

Christina Sevva,
Dimitrios Divanis,
Ariti Tsinari,
Petros Grammenos,
Styliani Laskou,
Stylianos Mantalobas,
Eleni Paschou,
Vasiliki Magra,
Periklis Kopsidas,
Isaak Kesisoglou,
Vassilios Liakopoulos,
Konstantinos Sapalidis

Affiliations

Christina Sevva: 3rd Surgical Department, University General Hospital of Thessaloniki “AHEPA”, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 1st St. Kiriakidi Street, 54621 Thessaloniki, Greece
Dimitrios Divanis: 2nd Department of Nephrology, University General Hospital of Thessaloniki “AHEPA”, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 1st St. Kiriakidi Street, 54621 Thessaloniki, Greece
Ariti Tsinari: 2nd Department of Nephrology, University General Hospital of Thessaloniki “AHEPA”, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 1st St. Kiriakidi Street, 54621 Thessaloniki, Greece
Petros Grammenos: Department of Anesthesiology, University General Hospital of Thessaloniki “AHEPA”, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 1st St. Kiriakidi Street, 54621 Thessaloniki, Greece
Styliani Laskou: 3rd Surgical Department, University General Hospital of Thessaloniki “AHEPA”, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 1st St. Kiriakidi Street, 54621 Thessaloniki, Greece
Stylianos Mantalobas: 3rd Surgical Department, University General Hospital of Thessaloniki “AHEPA”, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 1st St. Kiriakidi Street, 54621 Thessaloniki, Greece
Eleni Paschou: 3rd Surgical Department, University General Hospital of Thessaloniki “AHEPA”, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 1st St. Kiriakidi Street, 54621 Thessaloniki, Greece
Vasiliki Magra: 3rd Surgical Department, University General Hospital of Thessaloniki “AHEPA”, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 1st St. Kiriakidi Street, 54621 Thessaloniki, Greece
Periklis Kopsidas: School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 1st St. Kiriakidi Street, 54621 Thessaloniki, Greece
Isaak Kesisoglou: 3rd Surgical Department, University General Hospital of Thessaloniki “AHEPA”, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 1st St. Kiriakidi Street, 54621 Thessaloniki, Greece
Vassilios Liakopoulos: 2nd Department of Nephrology, University General Hospital of Thessaloniki “AHEPA”, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 1st St. Kiriakidi Street, 54621 Thessaloniki, Greece
Konstantinos Sapalidis: 3rd Surgical Department, University General Hospital of Thessaloniki “AHEPA”, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 1st St. Kiriakidi Street, 54621 Thessaloniki, Greece

DOI: https://doi.org/10.3390/medicina60050812
Journal volume & issue: Vol. 60, no. 5
p. 812

Abstract

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Background and Objectives: Secondary hyperparathyroidism (SHPT) poses a common condition among patients with chronic kidney disease (CKD) due to the chronic stimulation of the parathyroid glands as a result of persistently low calcium levels. As a first option for medical treatment, vitamin D receptor analogs (VDRAs) and calcimimetic agents are generally used. Apart from cinacalcet, which is orally taken, in recent years, another calcimimetic agent, etelcalcetide, is being administered intravenously during dialysis. Materials and Methods: In a 5-year retrospective study between 2018 and 2023, 52 patients undergoing dialysis were studied. The aim of this study is to highlight the possible effects and/or benefits that intravenously administered calcimimetic agents have on CKD patients. A total of 34 patients (65.4%) received cinacalcet and etelcalcetide while parathormone (PTH) and calcium serum levels were monitored on a monthly basis. Results: A total of 29 out of 33 patients (87.9%) that received treatment with etelcalcetide showed a significant decrease in PTH levels, which rose up to 57% compared to the initial values. None of the included patients needed to undergo parathyroidectomy (PTx) due to either extremely high and persistent PTH levels or severe side effects of the medications. It is generally strongly advised that parathyroidectomies should be performed by an expert surgical team. In recent years, a significant decrease in parathyroidectomies has been recorded globally, a fact that is mainly linked to the constantly wider use of new calcimimetic agents. This decrease in parathyroidectomies has resulted in an important decrease in complications occurring in cervical surgeries (e.g., perioperative hemorrhage and nerve damage). Conslusions: Despite the fact that these surgical complications cannot be easily compared to the pharmaceutical side effects, the recorded decrease in parathyroidectomies is considered to be notable, especially in cases of relapse where a difficult reoperation would be considered based on previously published guidelines.

Published in Medicina

ISSN: 1010-660X (Print); 1648-9144 (Online)
Publisher: MDPI AG
Country of publisher: Switzerland
LCC subjects: Medicine: Medicine (General)
Website: https://www.mdpi.com/journal/medicina

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