Bone Disease: Preparing for Your Parathyroidectomy

Patients with ESRD typically present with some form of bone mineral disease (BMD) due to secondary hyperparathyroidism. Secondary hyperparathyroidism develops in patients with ESRD because of various mechanisms that include increased phosphorus and decreased calcium and 1,25-dihydroxy vitamin D levels. Individualized medical therapy usually consists of controlling hyperphosphatemia with a prescribed nutrition plan, phosphate binders, and administering vitamin D/analog and calcimimetic agents to lower parathyroid hormone (PTH). However, some patients, despite medical therapy interventions, have persistently elevated phosphorous (>5.5 mg/dL) and PTH levels greater than 800 pg/mL, which may result in cardiovascular disease (vascular calcification) and reduced bone mass. Calciphylaxis, the calcification of small arterial vessels, may even occur, which can result in skin necrosis due to this change in BMD. For those individuals with persistently elevated PTH, calcium, or phosphorus and for those who are symptomatic (fractures, bone pain, pruritus), there is the surgical option to have a parathyroidectomy. Research suggests that a parathyroidectomy improves bone mineral density (decreases risk of fractures) and blood pressure through calcium stabilization and relieves some uremic pruritus. Although a parathyroidectomy can serve to improve a patient's quality of life, the surgery may appear intimidating and the etiology of BMD very complicated. One of the many roles of a renal reg...
Source: Journal of Renal Nutrition - Category: Urology & Nephrology Authors: Tags: Patient Education Source Type: research