الفهرس 
End Stage Renal DiseaseOnly 14 pages are availabe for public view
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Abstract
CKD-MBD leads to elevated PTH is associated with worse outcomes, as reduce kidney function, anemia and hypo-responsiveness to erythropoietin, cardiovascular calcifications, bone fractures and increased risk of all-cause and cardiovascular mortality, even before ESRD. Consequently, better PTH control in the pre-ESRD phases of CKD may improve eventual outcomes.
Thus, here we aimed to study the clinical and laboratory outcomes of treatment of CKD-MBD by medical versus surgical parathyroidectomy (sub-total parathyroidectomy with auto-transplantation of parathyroid tissue in the sternomastoid muscle) in ESRD patients on regular hemodialysis for more than 6 months.
This present study involved 50 ESRD patients on regular hemodialysis. They were classified according to treatment choice of MBD into two equal groups of 25 patients each; group (1) underwent surgical parathyroidectomy and group (2) patents who received medical treatment. They are 16 males (64 %) and 9 females (36 %) in group (1) and they are 15 males (60 %) and 10 females (40 %) in group (2), with total of 31 males (62%) and 19 females (38%). The ages of group (1) ranged from 28 to 68 years with mean ± SD of 54.6 ± 5.36 years and the ages of group (2) was ranged from 21 to 69 years with mean of 52.3 ± 6.42 years (p >0.05).
Risk factors and comorbidities include DM, hypertension, cardiac diseases, anemia, and glomerulonephritis were insignificant (p >0.05) in comparison between the two groups.
Also, laboratory findings showed insignificant difference between the two groups before treatment especially emphasized was calcium, phosphorus, alkaline phosphatase and PTH. However, after one week and one month of treatment, these parameters showed improvement as they were statistically significant (p <0.001 and <0.05) in surgical group (1) and medical treatment group (2), respectively, in comparison between before and after treatment.
In comparison of postoperative outcome of PTH improvement between the two groups; group (1) showed marked improvement than group (2) after 3 and 6 months of treatment (p <0.001).
In comparison of postoperative outcome of serum calcium level, the two groups showed nearly the same degree of improvement at the end of the follow-up period (p >0.05).
In comparison of postoperative serum phosphate level between the two groups; group (1) showed marked improvement than group (2) after treatment (p <0.01). However, alkaline phosphatase did not show significance of improvement between both groups at the end of the follow-up period (p >0.05).
group (1) patients showed some postoperative complications such as hungry bone syndrome in 12/25 patients (48%), neurological events in 2/25 patients (8%), calcium infusion injury and cardiovascular events each occur in 1/25 patients (4%). None had infection or massive bleeding during and after the operation.