| [ Summary ] |
The Japanese Society for Dialysis Therapy proposed guidelines for the management of secondary hyperparathyroidism in chronic dialysis patients. These guidelines were developed based on improving survival rates for hemodialysis patients. When blood phosphate, calcium or parathyroid hormone levels exceed target ranges, parathyroid intervention, including parathyroidectomy and percutaneous ethanol injection therapy, should be considered. When high PTH levels (intact-PTH > 500 pg / ml) persist and hyperphosphatemia or hypercalcemia can not be controlled by medical treatment, parathyroid intervention is strongly recommended. The detection of nodular hyperplastic glands (the volume of the gland estimated by ultrasonography > 500 mm3 or diameter of gland > 1 cm) is one useful factor to predict resistance to medical management. Concerning the progression of ectopic calcification, parathyroid intervention should be performed at a relatively early stage of secondary hyperparathyroidism. Superior results in efficacy rate, remission period and risk of relapse are obtained when PElT is restricted to patients with only one hyperplastic gland > 500 mm3. If more than one enlarged gland is detected with parathyroid imaging, parathyroidectomy should be chosen to avoid the injury to recurrent laryngeal nerve. |