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. 2022 Sep 1;276(3):e141-e176.
doi: 10.1097/SLA.0000000000005522. Epub 2022 Jul 18.

The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Secondary and Tertiary Renal Hyperparathyroidism

Sophie Dream  1 , Lindsay E Kuo  2 , Jennifer H Kuo  3 , Stuart M Sprague  4 , Fiemu E Nwariaku  5 , Myles Wolf  6 , John A Olson Jr  7 , Sharon M Moe  8 , Brenessa Lindeman  9 , Herbert Chen  9
Affiliations

The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Secondary and Tertiary Renal Hyperparathyroidism

Sophie Dream et al. Ann Surg. .

Abstract

Objective: To develop evidence-based recommendations for safe, effective, and appropriate treatment of secondary (SHPT) and tertiary (THPT) renal hyperparathyroidism.

Background: Hyperparathyroidism is common among patients with chronic kidney disease, end-stage kidney disease, and kidney transplant. The surgical management of SHPT and THPT is nuanced and requires a multidisciplinary approach. There are currently no clinical practice guidelines that address the surgical treatment of SHPT and THPT.

Methods: Medical literature was reviewed from January 1, 1985 to present January 1, 2021 by a panel of 10 experts in SHPT and THPT. Recommendations using the best available evidence was constructed. The American College of Physicians grading system was used to determine levels of evidence. Recommendations were discussed to consensus. The American Association of Endocrine Surgeons membership reviewed and commented on preliminary drafts of the content.

Results: These clinical guidelines present the epidemiology and pathophysiology of SHPT and THPT and provide recommendations for work-up and management of SHPT and THPT for all involved clinicians. It outlines the preoperative, intraoperative, and postoperative management of SHPT and THPT, as well as related definitions, operative techniques, morbidity, and outcomes. Specific topics include Pathogenesis and Epidemiology, Initial Evaluation, Imaging, Preoperative and Perioperative Care, Surgical Planning and Parathyroidectomy, Adjuncts and Approaches, Outcomes, and Reoperation.

Conclusions: Evidence-based guidelines were created to assist clinicians in the optimal management of secondary and tertiary renal hyperparathyroidism.

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Conflict of interest statement

S.M.M.: Scientific Advisor to Amgen, Ardelyx, and Sanifit. S.M.S.: Research Grants Amgen, Ardelyx, and Opko, Consulting Ardelyx. M.W. has received research support, honoraria or consultant fees from Akebia, Ardelyx, AstraZeneca, Bayer, Jnana, Pharmacosmos, Unicycive, and Walden Biosciences and has equity interests in Akebia, Unicycive and Walden Biosciences. The remaining authors report no conflicts of interest.

References

    1. Wilhelm SM, Wang TS, Ruan DT, et al. The American Association of Endocrine Surgeons Guidelines for definitive management of primary hyperparathyroidism. JAMA Surg. 2016;151:959–968.
    1. Ketteler M, Block GA, Evenepoel P, et al. 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. 2017;92:26–36.
    1. Kidney Disease: Improving Global Outcomes CKDMBDUWG. KDIGO 2017 clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD). Kidney Int Suppl. 2017;7:1–59
    1. Isakova T, Nickolas TL, Denburg M, et al. KDOQI US commentary on the 2017 KDIGO clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD). Am J Kidney Dis. 2017;70:737–751.
    1. Qaseem A, Snow V, Owens DK, et al. Clinical Guidelines Committee of the American College of P. The development of clinical practice guidelines and guidance statements of the American College of Physicians: summary of methods. Ann Intern Med. 2010;153:194–199.

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