Microwave ablation: an effective treatment for mild-to-moderate secondary hyperparathyroidism in patients undergoing haemodialysis

• Published in: International journal of hyperthermia Vol. 33; no. 8; pp. 946 - 952
• Main Authors: Wang, Gang, Liu, Sha, Liu, Xu, Qian, Linxue, Diao, Zongli, Liu, Wenhu
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 01.12.2017
• Subjects: Ablation Techniques; Aged; calcitriol; Calcitriol - therapeutic use; Combined Modality Therapy; efficacy; Female; haemodialysis; Humans; Hyperparathyroidism, Secondary - blood; Hyperparathyroidism, Secondary - diagnostic imaging; Hyperparathyroidism, Secondary - drug therapy; Hyperparathyroidism, Secondary - surgery; Male; Microwave ablation; Microwaves - therapeutic use; Middle Aged; Parathyroid Glands - diagnostic imaging; Parathyroid Glands - surgery; Parathyroid Hormone - blood; secondary hyperparathyroidism; Treatment Outcome; Ultrasonography, Interventional; Vitamins - therapeutic use; haemodialysis; Microwave ablation; secondary hyperparathyroidism; calcitriol; efficacy
• ISSN: 0265-6736; 1464-5157; 1464-5157
• DOI: 10.1080/02656736.2017.1357210

Background: Microwave ablation (MWA) is an effective treatment for severe secondary hyperparathyroidism (SHPT), but it can also be used for mild-to-moderate secondary hyperparathyroidism (SHPT). In this randomised, controlled study, the efficacy of MWA in the treatment of mild-to-moderate hyperparathyroidism is investigated. Materials and methods: We assessed outcomes 12 months after the randomisation of 28 patients with mild-to-moderate SHPT. The subjects received either MWA plus calcitriol or calcitriol alone. The primary end-points were the rate of achieving target levels of intact parathyroid hormone (iPTH), changes in iPTH levels and the rate of patients developing severe SHPT. Results: Primary end points: the overall rates of achieving target levels of iPTH were comparable between the MWA and calcitriol alone groups (24% vs. 22%, p = 0.85). However, the rate of iPTH <150 pg/mL (lower limit of the target range) in the MWA group was higher than that in the calcitriol alone group (23% vs. 8%, p = 0.02). The mean iPTH level in the MWA group after MWA was lower than that in the calcitriol alone group (373.09 ± 322.31 vs. 552.28 ± 361.87 pg/mL, p < 0.001). There was a significant difference in the change in iPTH levels over time within the MWA group (p < 0.001) but not in the calcitriol alone group. Only one patient developed severe SHPT in the MWA group, while six patients in the calcitriol alone group developed severe SHPT (p = 0.04). Conclusions: Compared with calcitriol alone, MWA plus calcitriol decreases iPTH levels and prevents the progression of mild-to-moderate SHPT.