Impact of Parathyroidectomy on Renal Function

Study Overview
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Brief Summary
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Primary hyperparathyroidism (PHPT) is a disorder of one or more of the parathyroid glands. The parathyroid gland(s) becomes overactive and secretes excess amounts of parathyroid hormone (PTH). As a result, the blood calcium rises to a level that is higher than normal. PHPT is associated with several other metabolic complications as osteoporosis, kidney stones, hypertension, insulin resistance, cardiac calcifications, cardiac arrhythmias, and kidney failure. Renal function deterioration over time has also been reported. However, the role of parathyroidectomy on renal function remains controversial in patients with PHPT. In some studies, surgical cure of PHPT has been shown to halt renal function deterioration in patients with coexisting renal disease. On the other hand, other studies showed no significant impact of parathyroidectomy on renal function. Consequently, the goal of this study was to evaluate renal function before and after parathyroidectomy in a large cohort of patients with pHPT.

Detailed Description
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Primary hyperparathyroidism (PHPT) is a disorder of one or more of the parathyroid glands. The parathyroid gland(s) becomes overactive and secretes excess amounts of parathyroid hormone (PTH). As a result, the blood calcium rises to a level that is higher than normal. PHPT is associated with several other metabolic complications as osteoporosis, kidney stones, hypertension, insulin resistance, cardiac calcifications, cardiac arrhythmias, and kidney failure. Renal function deterioration over time has also been reported. However, the role of parathyroidectomy on renal function remains controversial in patients with PHPT. In some studies, surgical cure of PHPT has been shown to halt renal function deterioration in patients with coexisting renal disease. On the other hand, other studies showed no significant impact of parathyroidectomy on renal function. Consequently, the goal of this study was to evaluate renal function before and after parathyroidectomy in a large cohort of patients with pHPT. Criteria are detailled in Outcomes measures

Official Title
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Impact of Parathyroidectomy on Renal Function in Patients With Primary Hyperparathyroidism

Conditions
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Primary Hyperparathyroidism

Intervention / Treatment
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* Procedure: parathyroidectomy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: - patients undergoing parathyroidectomy for primary hyperparathyroidism with surgical cure defined as postoperative normocalciemia Exclusion Criteria: patients on dialysis GFR < 15 ml/min renal graft

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Procedure: parathyroidectomy|surgical removal of parathyroid adenoma(s) with postoperative biological cure|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in renal function | glomerular filtration rate (CKD in mL/min) | preoperative, postoperative at 3, 6, and 12 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in calcium | Blood calcium level (in mg/L) | preoperative, postoperative at 3, 6, and 12 months | 
| Change in parathormone | Blood parathormone level (in ng/dL) | preoperative, postoperative at 3, 6, and 12 months | 
| Change in vitamin D | Blood vitamine D level (in ng/mL) | preoperative, postoperative at 3, 6, and 12 months | 
| Change in urinary calcium | Urine calcium level (in mg/24h) | preoperative, postoperative at 3, 6, and 12 months | 
| Change in insulin | Fasting blood insuline level (in mUI/L) | preoperative, postoperative at 3, 6, and 12 months | 
| Change in glycemia | Fasting blood glucose level (in g/L) | preoperative, postoperative at 3, 6, and 12 months | 
| Change in osteocalcin | Blood osteocalcin level (in ng/mL) | preoperative, postoperative at 3, 6, and 12 months | 
| Change in bone alkaline phosphatases | Blood bone alkaline phosphatases level (in microgr/L) | preoperative, postoperative at 3, 6, and 12 months | 
| Change in aldosterone | Blood aldosterone level (in pg/mL) | preoperative, postoperative at 3, 6, and 12 months | 
| Change in renin | Blood active renin (in pg/mL) | preoperative, postoperative at 3, 6, and 12 months | 
| Change in total cholesterol | Blood total cholesterol (in gr/L) | preoperative, postoperative at 3, 6, and 12 months | 
| Change in HDL cholesterol | Blood HDL Cholesterol (in gr/L) | preoperative, postoperative at 3, 6, and 12 months | 
| Change in LDL cholesterol | Blood LDL Cholesterol (in gr/L) | preoperative, postoperative at 3, 6, and 12 months | 
| Change in triglycerides | Blood triglycerides (in gr/L) | preoperative, postoperative at 3, 6, and 12 months | 
| CAC scoring on CT scan | CAC score (actual value) | preoperative | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Primary Hyperparathyroidism, Renal function