肾移植受者用钙化剂或甲状旁腺切除术：还有问题吗？系统回顾、荟萃分析和试验序贯分析。

IF 3.7 3区医学 Q2 Medicine

Endocrine Pub Date : 2025-02-08 DOI:10.1007/s12020-025-04189-9

Georgios Koimtzis, Leandros Stefanopoulos, Georgios Geropoulos, Nikos Tteralli, Kyriakos Psarras

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引用次数: 0

摘要

目的：继发性甲状旁腺功能亢进是慢性肾脏疾病最常见的并发症之一。目前治疗慢性肾病的最佳方法是肾移植。然而，甲状旁腺功能亢进并不总是在移植后解决，导致三级甲状旁腺功能亢进。第三期甲状旁腺功能亢进的治疗可以是药物（钙化剂）或手术（甲状旁腺切除术）。本研究的目的是比较药物和手术治疗在控制甲状旁腺功能亢进方面的效果和对移植肾功能的长期影响。方法：通过MEDLINE、EMBASE、Cochrane Central Register of Controlled Trials和Scopus数据库对截至2024年3月的相关研究进行系统综述和meta分析。我们比较了甲状旁腺激素、钙、肌酐和估计的肾小球滤过率在甲状旁腺切除术组和钙化剂组之间的差异。随后，我们进行了一项试验序列分析，以证实我们的发现。结果：最终纳入4项研究，共247例患者。甲状旁腺切除术导致甲状旁腺激素和钙水平明显下降（WMD 149.37, CI 95% 126.81-171.93, p）。结论：甲状旁腺切除术导致甲状旁腺激素和钙水平明显下降，对控制肾移植受者甲状旁腺功能亢进更有效。然而，移植肾的长期功能没有差异，因为手术组和内科组的肌酐和肾小球滤过值估计值相似。

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Calcimimetics or parathyroidectomy for kidney transplant recipients: is there still a question? a systematic review, meta-analysis and trial sequential analysis.

Purpose: Secondary hyperparathyroidism is one of the most common complications of chronic kidney disease. The optimal treatment for chronic kidney disease nowadays is kidney transplant. Nonetheless, hyperparathyroidism does not always resolve after transplantation leading to tertiary hyperparathyroidism. The management of tertiary hyperparathyroidism can be either medical (calcimimetics) or surgical (parathyroidectomy). The aim of this study is to compare the medical and surgical treatment in terms of control of hyperparathyroidism and long-term implications on kidney graft function.

Methods: We carried out a systematic review and meta-analysis of relevant studies up to March 2024 on MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Scopus databases. We compared the parathyroid hormone, calcium, creatinine and estimated glomerular filtration rate between the groups of patients that were treated with parathyroidectomy and those that were treated with calcimimetcs. Subsequently, we performed a trial sequential analysis to corroborate our findings.

Results: Four studies were included in the final analysis with a total number of 247 patients. Parathyroidectomy resulted in a greater decrease in parathyroid hormone and calcium levels (WMD 149.37, CI 95% 126.81-171.93, p < 0.0001 and WMD 0.7, CI 95% 0.45-0.96, p < 0.0001 respectively) but there was no difference between the surgical and medical management groups in the creatinine and eGFR levels (CI 95%, -0.62-0.17, p = 0.27 and CI 95%, -8.06 - 20.54 p = 0.39). The trial sequential analysis corroborated these findings.

Conclusion: Parathyroidectomy is more effective in controlling hyperparathyroidism in kidney transplant recipients, as it leads to a greater decrease in parathyroid hormone and calcium levels. However, there is no difference in the long-term function of the kidney graft, as the creatinine and estimated glomerular filtration values were similar in the surgical and medical management groups.

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来源期刊

Endocrine 医学-内分泌学与代谢

CiteScore

6.40

自引率

5.40%

发文量

期刊介绍： Well-established as a major journal in today’s rapidly advancing experimental and clinical research areas, Endocrine publishes original articles devoted to basic (including molecular, cellular and physiological studies), translational and clinical research in all the different fields of endocrinology and metabolism. Articles will be accepted based on peer-reviews, priority, and editorial decision. Invited reviews, mini-reviews and viewpoints on relevant pathophysiological and clinical topics, as well as Editorials on articles appearing in the Journal, are published. Unsolicited Editorials will be evaluated by the editorial team. Outcomes of scientific meetings, as well as guidelines and position statements, may be submitted. The Journal also considers special feature articles in the field of endocrine genetics and epigenetics, as well as articles devoted to novel methods and techniques in endocrinology. Endocrine covers controversial, clinical endocrine issues. Meta-analyses on endocrine and metabolic topics are also accepted. Descriptions of single clinical cases and/or small patients studies are not published unless of exceptional interest. However, reports of novel imaging studies and endocrine side effects in single patients may be considered. Research letters and letters to the editor related or unrelated to recently published articles can be submitted. Endocrine covers leading topics in endocrinology such as neuroendocrinology, pituitary and hypothalamic peptides, thyroid physiological and clinical aspects, bone and mineral metabolism and osteoporosis, obesity, lipid and energy metabolism and food intake control, insulin, Type 1 and Type 2 diabetes, hormones of male and female reproduction, adrenal diseases pediatric and geriatric endocrinology, endocrine hypertension and endocrine oncology.