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Parathyroidectomy in end stage renal disease

Mira Milas, MD, FACS
Section Editor
Sally E Carty, MD, FACS
Deputy Editor
Wenliang Chen, MD, PhD


Parathyroid surgery in patients with end stage renal disease (ESRD) is an effective therapy for normalization or stabilization of calcium and parathyroid hormone (PTH) metabolism, and for improving renal osteodystrophy [1-5].

Although the initial and predominant management of hyperparathyroidism (HPT) in ESRD is with medical therapy, approximately 10 percent of patients ultimately require surgery for ESRD-related HPT (sometimes referred to as renal HPT) [6]. Parathyroid surgery is also an effective therapy for patients with persistent HPT after renal transplantation [7-15].

The surgical techniques of parathyroidectomy in ESRD patients are discussed here. The medical management of HPT in patients with ESRD is discussed elsewhere. (See "Management of secondary hyperparathyroidism and mineral metabolism abnormalities in adult predialysis patients with chronic kidney disease" and "Management of secondary hyperparathyroidism and mineral metabolism abnormalities in dialysis patients" and "Indications for parathyroidectomy in end-stage renal disease" and "Persistent hyperparathyroidism after renal transplantation".)


Although medical therapies, including calcimimetics (eg, cinacalcet), have allowed some patients with end stage renal disease (ESRD) to be treated nonoperatively [7-15], symptomatic patients with markedly elevated parathyroid hormone (PTH) levels should be referred for parathyroid surgery if they become refractory to medical therapy. Preoperative hypocalcemia is a contraindication to surgery. The specific indications for parathyroidectomy in patients with ESRD are reviewed in detail separately. (See "Indications for parathyroidectomy in end-stage renal disease" and "Persistent hyperparathyroidism after renal transplantation".)


Knowledge of both normal and variant patterns of parathyroid anatomy is essential to successful parathyroid surgery. Normal parathyroid anatomy is reviewed elsewhere (see "Surgical anatomy of the parathyroid glands"). Variant patterns of parathyroid anatomy seen in end-stage renal disease (ESRD) patients are briefly discussed below.

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Literature review current through: Oct 2017. | This topic last updated: Dec 06, 2016.
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