| Theme |
The concepts of the new JSDT clinical guideline on CKD-MBD |
| Title |
Indications of and methods for parathyroid intervention |
| Author |
Ryoichi Ando |
Department of Nephrology, Musashino Red Cross Hospita |
| Author |
Takatoshi Kakuta |
Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine |
| [ Summary ] |
Situations concerning parathyroid intervention have changed since the introduction of cinacalcet hydrochloride. New CKD-MBD guidelines recommend parathyroidectomy (PTx) as a primary treatment and PEIT as an alternative if only one parathyroid gland is enlarged. PTx has been consistently recommended for severe secondary hyperparathyroidism refractory to medical treatment. Severe secondary hyperparathyroidism is defined as that with intact PTH levels over 500 pg/mL, or hyperphosphatemia or hypercalcemia which is difficult to manage with medical treatment. Indications of PTx and cinacalcet treatment overlap significantly. Given the absence of evidence comparing these two treatment approaches, therapeutic decisions should be made on a case-by-case basis, considering the patient's wishes and general condition. Patients who are refractory to cinacalcet treatment and those who have discontinued treatment due to adverse side effects should be considered for PTx. |