Perioperative considerations for parathyroidectomy in patients on dialysis. Perioperative considerations for parathyroidectomy in patients on dialysis.

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Presentation transcript:

Perioperative considerations for parathyroidectomy in patients on dialysis. Perioperative considerations for parathyroidectomy in patients on dialysis. Optimal parathyroid hormone (PTH) level remains unknown; although most would agree that persistent levels >800 pg/ml warrant parathyroidectomy, a lower threshold may be reasonable. *Preoperative (pre-op) ultrasound and 99mTc-sestamibi scintigraphy may help reduce the risk of recurrent disease by (1) detecting ectopic glands and (2) identifying which parathyroid gland has the lowest sestamibi uptake and can be used as the remnant tissue. †Used together to maintain serum calcium in normal range, because vitamin D analogs raise calcium, whereas calcimimetics lower calcium. Use of calcimimetics may be limited by gastrointestinal side effects and high cost. *Preoperative (pre-op) ultrasound and 99mTc-sestamibi scintigraphy may help reduce the risk of recurrent disease by (1) detecting ectopic glands and (2) identifying which parathyroid gland has the lowest sestamibi uptake and can be used as the remnant tissue. IV, intravenous; post-op, postoperation. Wei Ling Lau et al. CJASN 2018;13:952-961 ©2018 by American Society of Nephrology