Secondary hyperparathyroidism due to chronic kidney disease and access to clinical treatment and parathyroidectomy in Brazil: a nationwide survey.

Abstract

Introduction: Chronic kidney disease (CKD) may lead to secondary hyperparathyroidism (SHP) and its treatment is based on the control of hyperphosphatemia, hypocalcemia, and serum parathormone hormone levels (PTH) levels. Despite the advances in SHP treatment, therapeutic failure is frequent and CKD patients on dialysis require parathyroidectomy (PTx).

Aim: To update the 2011 survey, estimate the current prevalence of SHP in Brazilian dialysis centers, verify access to drugs, and identify obstacles to performing PTx.

Methods: A questionnaire was sent to active dialysis facilities. The results were compiled and statistically compared (p < 0.05).

Results: A total of 114 facilities successfully responded to the questionnaire, most of them in the Southeast region. Approximately 9% of the individuals (23,535) had serum PTH levels measurements above 1,000 pg/mL (10.7% were reported in the 2011 survey). A considerable number of the reported difficulties indicated limited availability of pivotal medications for SHP management and the associated complications. Of note, only 2.7% of the individuals were submitted to PTx. For those with PTx indication, the waiting time for the procedure was over two years in 28% of the cases. The main barriers to performing PTx were reported to be the long waiting time for PTx, the shortage of head and neck surgeons, and the lack of ward beds for hospital admissions.

Conclusion: Some aspects have improved since 2011. However, SHP remains highly prevalent in Brazil, and a significant number of individuals do not have access to PTx or experience long waiting times for this surgical procedure while facing substantial difficulties in obtaining clinical treatment.