The usefulness of parathyroid ultrasound in the diagnosis and definition of the treatment of secondary hyperparathyroidism in patients with chronic renal disease in dialytic therapy

Abstract

Introduction: Secondary hyperparathyroidism is a common complication in patients with chronic kidney disease (CKD). Objective: The objective of this study was to evaluate by imaging (neck ultrasound and parathyroid scintigraphy) patients with CKD on dialysis therapy with PTH values higher than the optimal recommended by the KDIGO guidelines in order to establish whether it was present in them with higher frequency the presence of nodular parathyroid hyperplasia, which could change its therapeutic approach. Materials and methods: This type of study is descriptive, observational, and retrospective from a single center. Patients with chronic kidney disease on dialysis therapy were included, and bone and mineral disorders were characterized by PTH values greater than 600 pg/ml, in whom anthropometric and laboratory variables were available. The included patients underwent ultrasound and parathyroid scintigraphy and were classified into three groups depending on the detection of images suggestive of parathyroid adenomas. Results: 653 patients with CKD on dialysis therapies were evaluated. PTH higher than 600 pg/ml was detected in 117 (17.9%). In 65 (55.56%), no images compatible with adenomas were detected (Group 1); in 52 (44.44%), adenomas were detected, dividing into 38 (32.48%) with adenomas smaller than 1000 mm3 (Group 2). ), and 14 (11.97%) with an adenoma larger than 1000 mm3 (Group 3). Group 3 had a longer time on dialysis and significantly higher values of calcium, alkaline phosphatase, and PTH. Conclusions: Nodular hyperplasia of the parathyroid glands can affect a significant number of patients with CKD on dialysis therapy, in whom the PTH value is higher than 600 pg/ml. Its detection and evaluation of the number and volume of adenomas could guide the nephrologist in proposing the best therapeutic option for them.