In Hyperparathyroidism patients with kidney transplantation, surgery is more effective than drug treatment

A study led by researchers from the Nephrology group at Bellvitge Biomedical Research Institute (IDIBELL) and the University Hospital of Bellvitge (HUB), compared the results of surgery with drug therapy in patients with tertiary hyperparathyroidism, ie after a kidney transplant. The results of the research have been published in the journal of greatest impact in Nephrology, Journal of the American Society of Nephrology.

This is the first clinical trial comparing these two treatments for this disease and has been funded by the Carlos III Health Institute within the call for independent clinical research projects.

Tertiary hyperparathyroidism

50% of patients with a kidney transplant presents tertiary hyperparathyroidism. This complication involves too much calcium, causing cardiovascular worsening by hypercalcemia, bone loss, and worsens the survival of the transplanted organ.

The study was performed in 30 patients. Half of them are operated and the other half have been treated with the usual drug. Researchers have found that surgery totally controls hypercalcemia, normalizes the secretion of parathyroid hormone (PTH) and improves bone density. While treatment only controls excess calcium in 67% of cases, has no effect on PTH and even slows the decline in bone density and does not stop the process.

The principal researcher of the study, Josep Maria Cruzado, explained that "if we have a surgical team with experience in this type of operation, our recommendation in these cases is to operate because it is positive both from the viewpoint of efficiency, since surgery It is a curative treatment, and from the economic point of view: the cost of surgery is equivalent to 14 months of treatment, and the drug must be taken chronically and can not be stopped."

The results of this study could change the clinical practice of tertiary hyperparathyroidism.

Cruzado has also explained that it is a minimally invasive surgery and involves only one day of hospitalization.

This study was coordinated by Josep M Cruzado, HUB Nephrology and Pablo Moreno of Surgery HUB and also collaborated in this work the nephrology, surgery, rheumatology and radiology services at HUB and further research service nephrology and kidney transplantation at the Clinical Hospital of Barcelona

Reference

Josep M. Cruzado*, Pablo Moreno†, José V. Torregrosa‡, Omar Taco*, Richard Mast§, Carmen Gómez-Vaquero‖, Carolina Polo*, Ignacio Revuelta‡, José Francos†, Joan Torras*, Arantxa García-Barrasa†, Oriol Bestard* and Josep M. Grinyó*. A Randomized Study Comparing Parathyroidectomy with Cinacalcet for Treating Hypercalcemia in Kidney Allograft Recipients with Hyperparathyroidism. JASN December 8, 2015. doi:10.1681/ASN.2015060622