Parathyroidectomy or cinacalcet: Do we still not know the best option for graft function in kidney-transplanted patients? A meta-analysis

被引:16
作者
Frey, Samuel [1 ,2 ]
Goronflot, Thomas [3 ]
Kerleau, Clarisse [4 ]
Gourraud, Pierre-Antoine [2 ,3 ]
Caillard, Cecile [1 ]
Hourmant, Maryvonne [2 ,4 ,5 ]
Mirallie, Eric [1 ,2 ]
Figueres, Lucile [2 ,4 ,5 ]
机构
[1] CHU Nantes, Inst Malad Appareil Digestif, Hotel Dieu, Chirurg Cancerol Digest & Endocrinienne, Nantes, France
[2] Univ Nantes, Nantes, France
[3] CHU Nantes, INSERM, Clin Donnees,CIC 1413, Pole Hosp Univ Sante Publ Sante Travail Pharm Ste, Nantes, France
[4] CHU Nantes, Inst Transplantat Urol Nephrol ITUN, Nantes, France
[5] CHU Nantes, Serv Nephrol Immunol Clin, Nantes, France
关键词
BONE-MINERAL DENSITY; PERSISTENT SECONDARY HYPERPARATHYROIDISM; TERTIARY HYPERPARATHYROIDISM; SURGICAL-TREATMENT; SUBTOTAL PARATHYROIDECTOMY; RENAL-TRANSPLANTATION; OPERATIVE TREATMENT; BLOOD-PRESSURE; HYPERCALCEMIA; RECIPIENTS;
D O I
10.1016/j.surg.2021.02.048
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background: Tertiary hyperparathyroidism occurs in 25% to 50% of kidney-transplanted patients. Indication of parathyroidectomy is now discussed, since the calcimimetic agent, cinacalcet, is an alternate option. The effects of either of these treatments on graft function remain controversial, studied only in small cohorts showing either decrease or absence of modification. We performed a meta-analysis to evaluate the evolution of graft function after surgical or medical treatment. Methods: Studies assessing graft function in tertiary hyperparathyroidism after parathyroidectomy or cinacalcet introduction were enrolled into quantitative analysis using Pubmed, Embase, and Cochrane databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis reporting guidelines. Among 68 screened studies, 18 had no missing data and were included for statistical analyses. We performed random effect meta-analysis to determine changes in serum creatinine and estimated glomerular filtration rate. Results: Seven studies assessing the evolution of graft function 6 and/or 12 months after parathyroidectomy and 13 after administration of cinacalcet were included. Meta-analysis found no significant variations after parathyroidectomy in serum creatinine (6 studies, 314 patients) and estimated glomerular filtration rate (2 studies, 105 patients). No significant variation was found after administration of cinacalcet in serum creatinine (10 studies, 404 patients) and estimated glomerular filtration rate (6 studies, 149 patients). A significant heterogeneity between the studies (P < .01, Cochran's Q) was found. Conclusion: Meta-analysis shows that parathyroidectomy and cinacalcet do not significantly impair graft function in patients with tertiary hyperparathyroidism. However, the significant heterogeneity between selected studies, partially explained by the lack of consensual definition of tertiary hyperparathyroidism, limits the conclusions of all previously published series. (c) 2021 Elsevier Inc. All rights reserved.
引用
收藏
页码:727 / 735
页数:9
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