Journal of Nephrology

, Volume 31, Issue 4, pp 585–591 | Cite as

CKD-MBD management: what is the role of parathyroidectomy? Results from a nationwide survey in Italy

  • Antonio BellasiEmail author
  • Luigi Morrone
  • Maria Cristina Mereu
  • Carlo Massimetti
  • Elena Pelizzaro
  • Giuseppe Cianciolo
  • Marzia Pasquali
  • Vincenzo Panuccio
  • on behalf of the working group on CKD-MBD of the Italian Society of Nephrology
Original Article


We herein report on a nationwide survey conducted in Italy to investigate the use of parathyroidectomy (PTX). In spite of the availability of newer and more effective drugs to control chronic kidney disease mineral bone disorder (CKD-MBD) biochemical abnormalities, PTX still remains a resource for nephrologists to use. However, observational analyses suggest that in recent years there has been a constant decline in the number of patients undergoing PTX. The reasons are not clear, though the increasing age and number of comorbidities of dialysis patients may partly explain this trend. Poor adherence to guidelines and/or geographical as well as logistic factors may also contribute to the lower use of PTX. The working group on CKD-MBD of the Italian Society of Nephrology launched a nationwide survey to investigate clinical practice patterns for PTX in Italy and identify modifiable factors that may limit accessibility to surgery.


Parathyroidectomy CKD-MBD Dialysis CKD 



The working group on CKD-MBD of the Italian Society thanks all centers that responded to the survey. A complete list of the centers is available in Supplementary Table 1.

Compliance with ethical standards

Conflict of interest

The authors have no conflict of interest to disclose.

Research involving human participants and/or animals and informed consent

For this type of study formal ethical approval and informed consent are not required.

Supplementary material

40620_2018_481_MOESM1_ESM.docx (23 kb)
Supplementary material 1 (DOCX 22 KB)


  1. 1.
    Moe S, Drueke T, Cunningham J et al (2006) Definition, evaluation, and classification of renal osteodystrophy: a position statement from kidney disease: improving global outcomes (KDIGO). Kidney Int 69:1945–1953CrossRefPubMedGoogle Scholar
  2. 2.
    Yamamoto S, Fukagawa M (2017) Uremic Toxicity and Bone in CKD. J Nephrol 30:623–627CrossRefPubMedGoogle Scholar
  3. 3.
    Block GA, Klassen PS, Lazarus JM et al (2004) Mineral metabolism, mortality, and morbidity in maintenance hemodialysis. J Am Soc Nephrol 15:2208–2218CrossRefPubMedGoogle Scholar
  4. 4.
    Cunningham J, Locatelli F, Rodriguez M (2011) Secondary hyperparathyroidism: pathogenesis, disease progression, and therapeutic options. Clin J Am Soc Nephrol 6:913–921CrossRefPubMedGoogle Scholar
  5. 5.
    Ketteler M, Block GA, Evenepoel P et al (2017) Executive summary of the 2017 KDIGO Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) Guideline Update: what’s changed and why it matters. Kidney Int 92:26–36CrossRefPubMedGoogle Scholar
  6. 6.
    Kidney Disease: Improving Global Outcomes CKDMBDWG (2009) KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl S1–130Google Scholar
  7. 7.
    Cozzolino M, Tomlinson J, Walsh L et al (2015) Emerging drugs for secondary hyperparathyroidism. Expert Opin Emerg Drugs 20:197–208CrossRefPubMedGoogle Scholar
  8. 8.
    Tartaglione L, Pasquali M, Rotondi S et al (2017) Positioning novel biologicals in CKD-mineral and bone disorders. J Nephrol 30:689–699CrossRefPubMedGoogle Scholar
  9. 9.
    Apetrii M, Goldsmith D, Nistor I et al (2017) Impact of surgical parathyroidectomy on chronic kidney disease-mineral and bone disorder (CKD-MBD) - A systematic review and meta-analysis. PLoS One 12:e0187025CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Mazzaferro S, Brancaccio D, Messa P et al (2011) Management of secondary hyperparathyroidism in Italy: results of the Italian FARO survey. J Nephrol 24:225–235CrossRefPubMedGoogle Scholar
  11. 11.
    Li S, Chen YW, Peng Y et al (2011) Trends in parathyroidectomy rates in US hemodialysis patients from 1992 to 2007. Am J Kidney Dis 57:602–611CrossRefPubMedGoogle Scholar
  12. 12.
    Messa P (2015) Parathyroidectomy and patient survival in CKD patients. Nephrol Dial Transplant 30:1944–1946CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Tentori F, Zepel L, Fuller DS et al (2015) The DOPPS practice monitor for US dialysis care: PTH levels and management of mineral and bone disorder in US hemodialysis patients. Am J Kidney Dis 66:536–539CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Tentori F, Wang M, Bieber BA et al (2015) Recent changes in therapeutic approaches and association with outcomes among patients with secondary hyperparathyroidism on chronic hemodialysis: the DOPPS study. Clin J Am Soc Nephrol 10:98–109CrossRefPubMedGoogle Scholar
  15. 15.
    Chertow GM, Block GA, Correa-Rotter R et al (2012) Effect of cinacalcet on cardiovascular disease in patients undergoing dialysis. N Engl J Med 367:2482–2494CrossRefPubMedGoogle Scholar
  16. 16.
    Parfrey PS, Chertow GM, Block GA et al (2013) The clinical course of treated hyperparathyroidism among patients receiving hemodialysis and the effect of cinacalcet: the EVOLVE trial. J Clin Endocrinol Metab 98:4834–4844CrossRefPubMedGoogle Scholar
  17. 17.
    van der Plas WY, Dulfer RR, Engelsman AF et al (2017) Effect of parathyroidectomy and cinacalcet on quality of life in patients with end-stage renal disease-related hyperparathyroidism: a systematic review. Nephrol Dial Transplant 32:1902–1908CrossRefPubMedGoogle Scholar
  18. 18.
    Chen L, Wang K, Yu S et al (2016) Long-term mortality after parathyroidectomy among chronic kidney disease patients with secondary hyperparathyroidism: a systematic review and meta-analysis. Ren Fail 38:1050–1058CrossRefPubMedGoogle Scholar
  19. 19.
    Ishani A, Liu J, Wetmore JB et al (2015) Clinical outcomes after parathyroidectomy in a nationwide cohort of patients on hemodialysis. Clin J Am Soc Nephrol 10:90–97CrossRefPubMedGoogle Scholar
  20. 20.
    Locatelli F, Messa P, Bellasi A et al (2013) What can we learn from a statistically inconclusive trial? Consensus conference on the EVOLVE study results. G Ital Nefrol 30Google Scholar
  21. 21.
    Belozeroff V, Chertow GM, Graham CN et al (2015) Economic Evaluation of Cinacalcet in the United States: The EVOLVE Trial. Value Health 18:1079–1087CrossRefPubMedGoogle Scholar
  22. 22.
    Gallieni M, De Luca N, Santoro D et al (2016) Management of CKD-MBD in non-dialysis patients under regular nephrology care: a prospective multicenter study. J Nephrol 29:71–78CrossRefPubMedGoogle Scholar
  23. 23.
    Li JG, Xiao ZS, Hu XJ et al (2017) Total parathyroidectomy with forearm auto-transplantation improves the quality of life and reduces the recurrence of secondary hyperparathyroidism in chronic kidney disease patients. Medicine (Baltimore) 96:e9050CrossRefGoogle Scholar
  24. 24.
    Minuto M, Vera L, Ansaldo GL et al (2014) Modern approach to parathyroidectomy. G Ital Nefrol 31Google Scholar

Copyright information

© Italian Society of Nephrology 2018

Authors and Affiliations

  • Antonio Bellasi
    • 1
    Email author
  • Luigi Morrone
    • 2
  • Maria Cristina Mereu
    • 3
  • Carlo Massimetti
    • 4
  • Elena Pelizzaro
    • 5
  • Giuseppe Cianciolo
    • 5
  • Marzia Pasquali
    • 6
  • Vincenzo Panuccio
    • 7
  • on behalf of the working group on CKD-MBD of the Italian Society of Nephrology
  1. 1.Nephrology and Dialysis Unit, ASST-LarianaComoItaly
  2. 2.Struttura Complessa di Nefrologia e Dialisi, P.O.C. “S.S. Annunziata”, A.S.L. TarantoTarantoItaly
  3. 3.Ospedale N.S. di Bonaria, San Gavino Mon.leCagliariItaly
  4. 4.Centro di Riferimento di Nefrologia e Dialisi, Ospedale BelcolleViterboItaly
  5. 5.U.O.C. Nefrologia, Dialisi e Trapianto, Azienda Ospedaliera Universitaria Sant’Orsola-MalpighiBolognaItaly
  6. 6.UOC Nefrologia-Azienda Ospedaliero-Universitaria Policlinico Umberto I RomaRomeItaly
  7. 7.UOC di Nefrologia, Dialisi e Trapianto del GOM “BMM” di Reggio CalabriaReggio CalabriaItaly

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