Actualities in surgical treatment of uremic secondary hyperparathyroidism_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

DUAN Menglian , CHEN Chuang ,  SUN Shengrong

Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan 430060, P. R. China;

Corresponding author：

SUN Shengrong, Email: sun137@sina.com

Keywords：

secondary hyperparathyroidism; uremia; surgery; kidney transplant; review

DOI：

10.7507/1007-9424.201911010

Video：

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Objective To summarize the current treatment status of uremic secondary hyperparathyroidism (SHPT) in order to improve the understanding of uremic SHPT and to guide clinical work.Method The relevant literatures at home and abroad on surgical treatment of uremic SHPT were readed and reviewed.Results For intractable SHPT patients with ineffective medical treatment, surgical treatment was still irreplaceable, which could significantly improve biochemical indicators and quality of life of SHPT patients. However, there was no unified standard for surgical indications and the choice of different operation methods. In addition, there was a certain controversy about whether there was a need for preoperative parathyroidectomy in patients with SHPT who were willing to have a kidney transplant.Conclusion Although there are still some problems need to be solved in surgical treatment of SHPT, however, it’s widely recognized and used by clinicians, which can improve the symptoms of SHPT patients and bring bettersurvival benefits.

Citation： DUAN Menglian, CHEN Chuang, SUN Shengrong. Actualities in surgical treatment of uremic secondary hyperparathyroidism. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(8): 1038-1043. doi: 10.7507/1007-9424.201911010 Copy

1.	Apetrii M, Goldsmith D, Nistor I, et al. Impact of surgical parathyroidectomy on chronic kidney disease-mineral and bone disorder (CKD-MBD)–a systematic review and meta-analysis. PLoS One, 2017, 12(11): e0187025.
2.	Valderrábano F, Berthoux FC, Jones EH, et al. Report on management of renal failure in Europe, XXV, 1994 end stage renal disease and dialysis report. The EDTA-ERA Registry. European Dialysis and Transplant Association-European Renal Association. Nephrol Dial Transplant, 1996, 11(Suppl 1): 2-21.
3.	Portillo MR, Rodríguez-Ortiz ME. Secondary hyperparthyroidism: pathogenesis, diagnosis, preventive and therapeutic strategies. Rev Endocr Metab Disord, 2017, 18(1): 79-95.
4.	Goldsmith D, Covic A, Vervloet M, et al. Should patients with CKD stage 5D and biochemical evidence of secondary hyperparathyroidism be prescribed calcimimetic therapy? An ERA-EDTA position statement. Nephrol Dial Transplant, 2015, 30(5): 698-700.
5.	程若川, 苏艳军. 我国外科治疗肾性继发性甲状旁腺功能亢进的适应证与风险思考. 中国临床新医学, 2019, 12(3): 241-246.
6.	陈海珍, 陈曦. 肾性继发性甲状旁腺功能亢进症的多学科协作治疗. 外科理论与实践, 2018, 23(2): 103-107.
7.	National Kidney Foundation. K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis, 2003, 42(4 Suppl 3): S1-S201.
8.	Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl, 2009, (113): S1-S130.
9.	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(1): 26-36.
10.	Guideline Working Group, Japanese Society for Dialysis Therapy. Clinical practice guideline for the management of secondary hyperparathyroidism in chronic dialysis patients. Ther Apher Dial, 2008, 12(6): 514-525.
11.	王莉, 李贵森, 刘志红. 中华医学会肾脏病学分会《慢性肾脏病矿物质和骨异常诊治指导》. 肾脏病与透析肾移植杂志, 2013, 22(6): 554-559.
12.	田文, 贺青卿, 姜可伟, 等. 慢性肾功能衰竭继发甲状旁腺功能亢进外科临床实践专家共识. 中国实用外科杂志, 2016, 36(5): 481-486.
13.	Stanbury SW, Lumb GA, Nicholson WF. Elective subtotal parathyroidectomy for renal hyperparathyroidism. Lancet, 1960, 1(7128): 793-799.
14.	代文杰, 徐德全. 继发性甲状旁腺功能亢进外科治疗. 中国实用外科杂志, 2014, 34(4): 314-317.
15.	王海峰, 张凌, 姚力, 等. 三种不同甲状旁腺切除术治疗继发性甲状旁腺功能亢进 425 例疗效比较. 中国血液净化, 2016, 15(9): 455-458.
16.	Myrick SR, Radomski JS, Michael HJ, et al. Surgical treatment of secondary hyperparathyroidism in patients with chronic renal failure by sub-total parathyroidectomy. Am Surg, 1994, 60(8): 638-640.
17.	Jia X, Wang R, Zhang C, et al. Long-term outcomes of total parathyroidectomy with or without autoimplantation for hyperparathyroidism in chronic kidney disease: a meta-analysis. Ther Apher Dial, 2015, 19(5): 477-485.
18.	Alveryd A. Parathyroid glands in thyroid surgery. Ⅰ. Anatomy of parathyroid glands. Ⅱ. Postoperative hypoparathyroidism–identification and autotransplantation of parathyroid glands. Acta Chir Scand, 1968, 389: 1-120.
19.	谢胜学, 陈江明, 余立权, 等. 尿毒症继发性甲状旁腺功能亢进两种自体移植方式的疗效比较. 中华内分泌外科杂志, 2015, 9(4): 287-290.
20.	Hsu YC, Hung CJ. Intramuscular and subcutaneous forearm parathyroid autograft hyperplasia in renal dialysis patients: a retrospective cohort study. Surgery, 2015, 158(5): 1331-1338.
21.	乔楠, 付庆锋, 李鸿博, 等. 继发性甲状旁腺功能亢进外科治疗中甲状旁腺自体移植现状. 中国实用外科杂志, 2019, 39(4): 379-381.
22.	Ponce de León-Ballesteros G, Velázquez-Fernández D, Hernández-Calderón FJ, et al. Hypoparathyroidism after total thyroidectomy: importance of the intraoperative management of the parathyroid glands. World J Surg, 2019, 43(7): 1728-1735.
23.	何映琴. 甲状旁腺切除治疗尿毒症继发性甲状旁腺功能亢进症患者的临床观察. 中国现代药物应用, 2019, 13(12): 65-66.
24.	Chen L, Wang K, Yu S, et al. Long-term mortality after parathyroidectomy among chronic kidney disease patients with secondary hyperparathyroidism: a systematic review and meta-analysis. Ren Fail, 2016, 38(7): 1050-1058.
25.	Schneider R, Slater EP, Karakas E, et al. Initial parathyroid surgery in 606 patients with renal hyperparathyroidism. World J Surg, 2012, 36(2): 318-326.
26.	Steffen L, Moffa G, Müller PC, et al. Secondary hyperparathyroidism: recurrence after total parathyroidectomy with autotransplantation. Swiss Med Wkly, 2019, 149: w20160.
27.	Shih ML, Duh QY, Hsieh CB, et al. Total parathyroidectomy without autotransplantation for secondary hyperparathyroidism. World J Surg, 2009, 33(2): 248-254.
28.	Yuan Q, Liao Y, Zhou R, et al. Subtotal parathyroidectomy versus total parathyroidectomy with autotransplantation for secondary hyperparathyroidism: an updated systematic review and meta-analysis. Langenbecks Arch Surg, 2019, 404(6): 669-679.
29.	Liu ME, Qiu NC, Zha SL, et al. To assess the effects of parathyroidectomy (TPTX versus TPTX+AT) for secondary hyperparathyroidism in chronic renal failure: a systematic review and meta-analysis. Int J Surg, 2017, 44: 353-362.
30.	Li C, Lv L, Wang H, et al. Total parathyroidectomy versus total parathyroidectomy with autotransplantation for secondary hyperparathyroidism: systematic review and meta-analysis. Ren Fail, 2017, 39(1): 678-687.
31.	赵沙沙, 闻萍, 甘巍, 等. 继发性甲状旁腺功能亢进症甲状旁腺切除术后并发症分析. 肾脏病与透析肾移植杂志, 2019, 28(1): 19-23.
32.	Ishani A, Liu J, Wetmore JB, et al. Clinical outcomes after parathyroidectomy in a nationwide cohort of patients on hemodialysis. Clin J Am Soc Nephrol, 2015, 10(1): 90-97.
33.	Marx SJ. Hyperparathyroid and hypoparathyroid disorders. N Engl J Med, 2000, 343(25): 1863-1875.
34.	Ho LC, Hung SY, Wang HH, et al. parathyroidectomy associates with reduced mortality in taiwanese dialysis patients with hyperparathyroidism: evidence for the controversy of current guidelines. Sci Rep, 2016, 6: 19150.
35.	Ockert S, Willeke F, Richter A, et al. Total parathyroidectomy without autotransplantation as a standard procedure in the treatment of secondary hyperparathyroidism. Langenbecks Arch Surg, 2002, 387(5-6): 204-209.
36.	Pattou FN, Pellissier LC, Noël C, et al. Supernumerary parathyroid glands: frequency and surgical significance in treatment of renal hyperparathyroidism. World J Surg, 2000, 24(11): 1330-1334.
37.	Stracke S, Keller F, Steinbach G, et al. Long-term outcome after total parathyroidectomy for the management of secondary hyperparathyroidism. Nephron Clin Pract, 2009, 111(2): c102-c109.
38.	李朋, 梁伟, 姜蕾, 等. 手术治疗继发性甲状旁腺功能亢进 25 例临床分析. 中国实用外科杂志, 2015, 35(2): 205-207.
39.	Ding C, Buckingham B, Levine MA. Familial isolated hypoparathyroidism caused by a mutation in the gene for the transcription factor GCMB. J Clin Invest, 2001, 108(8): 1215-1220.
40.	Schneider R, Bartsch DK, Schlosser K. Relevance of bilateral cervical thymectomy in patients with renal hyperparathyroidism: analysis of 161 patients undergoing reoperative parathyroidectomy. World J Surg, 2013, 37(9): 2155-2161.
41.	段梦莲, 陈创, 孙圣荣. 50例尿毒症继发性甲状旁腺功能亢进患者的手术疗效分析. 中国普外基础与临床杂志, 2019, 26(1): 61-66.
42.	La Manna G. Parathyroidectomy before or after transplantation: a dilemma still open! Artif Organs, 2018, 42(2): 127-130.
43.	Delos Santos R, Rossi A, Coyne D, et al. Management of post-transplant hyperparathyroidism and bone disease. Drugs, 2019, 79(5): 501-513.
44.	Gwinner W, Suppa S, Mengel M, et al. Early calcification of renal allografts detected by protocol biopsies: causes and clinical implications. Am J Transplant, 2005, 5(8): 1934-1941.
45.	Bouquegneau A, Salam S, Delanaye P, et al. Bone disease after kidney transplantation. Clin J Am Soc Nephrol, 2016, 11(7): 1282-1296.
46.	Jeon HJ, Kim YJ, Kwon HY, et al. Impact of parathyroidectomy on allograft outcomes in kidney transplantation. Transpl Int, 2012, 25(12): 1248-1256.
47.	Littbarski SA, Kaltenborn A, Gwiasda J, et al. Timing of parathyroidectomy in kidney transplant candidates with secondary hyperparathryroidism: effect of pretransplant versus early or late post-transplant parathyroidectomy. Surgery, 2018, 163(2): 373-380.
48.	Tseng PY, Yang WC, Yang CY, et al. Long-term outcomes of parathyroidectomy in kidney transplant recipients with persistent hyperparathyroidism. Kidney Blood Press Res, 2015, 40(4): 386-394.
49.	Callender GG, Malinowski J, Javid M, et al. Parathyroidectomy prior to kidney transplant decreases graft failure. Surgery, 2017, 161(1): 44-50.
50.	Hod T, Riella LV, Chandraker A. Recombinant PTH therapy for severe hypoparathyroidism after kidney transplantation in pre-transplant parathyroidectomized patients: review of the literature and a case report. Clin Transplant, 2015, 29(11): 951-957.
51.	Evenepoel P, Claes K, Kuypers D, et al. Impact of parathyroidectomy on renal graft function, blood pressure and serum lipids in kidney transplant recipients: a single centre study. Nephrol Dial Transplant, 2005, 20(8): 1714-1720.
52.	Chen HM, Dai JJ, Zhu R, et al. Parathyroid hormone-related protein induces fibronectin up-regulation in rat mesangial cells through reactive oxygen species/Src/EGFR signaling. Biosci Rep, 2019, 39(4): BSR20182293.
53.	Evenepoel P, Claes K, Kuypers DR, et al. Parathyroidectomy after successful kidney transplantation: a single centre study. Nephrol Dial Transplant, 2007, 22(6): 1730-1737.

1. Apetrii M, Goldsmith D, Nistor I, et al. Impact of surgical parathyroidectomy on chronic kidney disease-mineral and bone disorder (CKD-MBD)–a systematic review and meta-analysis. PLoS One, 2017, 12(11): e0187025.
2. Valderrábano F, Berthoux FC, Jones EH, et al. Report on management of renal failure in Europe, XXV, 1994 end stage renal disease and dialysis report. The EDTA-ERA Registry. European Dialysis and Transplant Association-European Renal Association. Nephrol Dial Transplant, 1996, 11(Suppl 1): 2-21.
3. Portillo MR, Rodríguez-Ortiz ME. Secondary hyperparthyroidism: pathogenesis, diagnosis, preventive and therapeutic strategies. Rev Endocr Metab Disord, 2017, 18(1): 79-95.
4. Goldsmith D, Covic A, Vervloet M, et al. Should patients with CKD stage 5D and biochemical evidence of secondary hyperparathyroidism be prescribed calcimimetic therapy? An ERA-EDTA position statement. Nephrol Dial Transplant, 2015, 30(5): 698-700.
5. 程若川, 苏艳军. 我国外科治疗肾性继发性甲状旁腺功能亢进的适应证与风险思考. 中国临床新医学, 2019, 12(3): 241-246.
6. 陈海珍, 陈曦. 肾性继发性甲状旁腺功能亢进症的多学科协作治疗. 外科理论与实践, 2018, 23(2): 103-107.
7. National Kidney Foundation. K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis, 2003, 42(4 Suppl 3): S1-S201.
8. Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl, 2009, (113): S1-S130.
9. 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(1): 26-36.
10. Guideline Working Group, Japanese Society for Dialysis Therapy. Clinical practice guideline for the management of secondary hyperparathyroidism in chronic dialysis patients. Ther Apher Dial, 2008, 12(6): 514-525.
11. 王莉, 李贵森, 刘志红. 中华医学会肾脏病学分会《慢性肾脏病矿物质和骨异常诊治指导》. 肾脏病与透析肾移植杂志, 2013, 22(6): 554-559.
12. 田文, 贺青卿, 姜可伟, 等. 慢性肾功能衰竭继发甲状旁腺功能亢进外科临床实践专家共识. 中国实用外科杂志, 2016, 36(5): 481-486.
13. Stanbury SW, Lumb GA, Nicholson WF. Elective subtotal parathyroidectomy for renal hyperparathyroidism. Lancet, 1960, 1(7128): 793-799.
14. 代文杰, 徐德全. 继发性甲状旁腺功能亢进外科治疗. 中国实用外科杂志, 2014, 34(4): 314-317.
15. 王海峰, 张凌, 姚力, 等. 三种不同甲状旁腺切除术治疗继发性甲状旁腺功能亢进 425 例疗效比较. 中国血液净化, 2016, 15(9): 455-458.
16. Myrick SR, Radomski JS, Michael HJ, et al. Surgical treatment of secondary hyperparathyroidism in patients with chronic renal failure by sub-total parathyroidectomy. Am Surg, 1994, 60(8): 638-640.
17. Jia X, Wang R, Zhang C, et al. Long-term outcomes of total parathyroidectomy with or without autoimplantation for hyperparathyroidism in chronic kidney disease: a meta-analysis. Ther Apher Dial, 2015, 19(5): 477-485.
18. Alveryd A. Parathyroid glands in thyroid surgery. Ⅰ. Anatomy of parathyroid glands. Ⅱ. Postoperative hypoparathyroidism–identification and autotransplantation of parathyroid glands. Acta Chir Scand, 1968, 389: 1-120.
19. 谢胜学, 陈江明, 余立权, 等. 尿毒症继发性甲状旁腺功能亢进两种自体移植方式的疗效比较. 中华内分泌外科杂志, 2015, 9(4): 287-290.
20. Hsu YC, Hung CJ. Intramuscular and subcutaneous forearm parathyroid autograft hyperplasia in renal dialysis patients: a retrospective cohort study. Surgery, 2015, 158(5): 1331-1338.
21. 乔楠, 付庆锋, 李鸿博, 等. 继发性甲状旁腺功能亢进外科治疗中甲状旁腺自体移植现状. 中国实用外科杂志, 2019, 39(4): 379-381.
22. Ponce de León-Ballesteros G, Velázquez-Fernández D, Hernández-Calderón FJ, et al. Hypoparathyroidism after total thyroidectomy: importance of the intraoperative management of the parathyroid glands. World J Surg, 2019, 43(7): 1728-1735.
23. 何映琴. 甲状旁腺切除治疗尿毒症继发性甲状旁腺功能亢进症患者的临床观察. 中国现代药物应用, 2019, 13(12): 65-66.
24. Chen L, Wang K, Yu S, et al. Long-term mortality after parathyroidectomy among chronic kidney disease patients with secondary hyperparathyroidism: a systematic review and meta-analysis. Ren Fail, 2016, 38(7): 1050-1058.
25. Schneider R, Slater EP, Karakas E, et al. Initial parathyroid surgery in 606 patients with renal hyperparathyroidism. World J Surg, 2012, 36(2): 318-326.
26. Steffen L, Moffa G, Müller PC, et al. Secondary hyperparathyroidism: recurrence after total parathyroidectomy with autotransplantation. Swiss Med Wkly, 2019, 149: w20160.
27. Shih ML, Duh QY, Hsieh CB, et al. Total parathyroidectomy without autotransplantation for secondary hyperparathyroidism. World J Surg, 2009, 33(2): 248-254.
28. Yuan Q, Liao Y, Zhou R, et al. Subtotal parathyroidectomy versus total parathyroidectomy with autotransplantation for secondary hyperparathyroidism: an updated systematic review and meta-analysis. Langenbecks Arch Surg, 2019, 404(6): 669-679.
29. Liu ME, Qiu NC, Zha SL, et al. To assess the effects of parathyroidectomy (TPTX versus TPTX+AT) for secondary hyperparathyroidism in chronic renal failure: a systematic review and meta-analysis. Int J Surg, 2017, 44: 353-362.
30. Li C, Lv L, Wang H, et al. Total parathyroidectomy versus total parathyroidectomy with autotransplantation for secondary hyperparathyroidism: systematic review and meta-analysis. Ren Fail, 2017, 39(1): 678-687.
31. 赵沙沙, 闻萍, 甘巍, 等. 继发性甲状旁腺功能亢进症甲状旁腺切除术后并发症分析. 肾脏病与透析肾移植杂志, 2019, 28(1): 19-23.
32. Ishani A, Liu J, Wetmore JB, et al. Clinical outcomes after parathyroidectomy in a nationwide cohort of patients on hemodialysis. Clin J Am Soc Nephrol, 2015, 10(1): 90-97.
33. Marx SJ. Hyperparathyroid and hypoparathyroid disorders. N Engl J Med, 2000, 343(25): 1863-1875.
34. Ho LC, Hung SY, Wang HH, et al. parathyroidectomy associates with reduced mortality in taiwanese dialysis patients with hyperparathyroidism: evidence for the controversy of current guidelines. Sci Rep, 2016, 6: 19150.
35. Ockert S, Willeke F, Richter A, et al. Total parathyroidectomy without autotransplantation as a standard procedure in the treatment of secondary hyperparathyroidism. Langenbecks Arch Surg, 2002, 387(5-6): 204-209.
36. Pattou FN, Pellissier LC, Noël C, et al. Supernumerary parathyroid glands: frequency and surgical significance in treatment of renal hyperparathyroidism. World J Surg, 2000, 24(11): 1330-1334.
37. Stracke S, Keller F, Steinbach G, et al. Long-term outcome after total parathyroidectomy for the management of secondary hyperparathyroidism. Nephron Clin Pract, 2009, 111(2): c102-c109.
38. 李朋, 梁伟, 姜蕾, 等. 手术治疗继发性甲状旁腺功能亢进 25 例临床分析. 中国实用外科杂志, 2015, 35(2): 205-207.
39. Ding C, Buckingham B, Levine MA. Familial isolated hypoparathyroidism caused by a mutation in the gene for the transcription factor GCMB. J Clin Invest, 2001, 108(8): 1215-1220.
40. Schneider R, Bartsch DK, Schlosser K. Relevance of bilateral cervical thymectomy in patients with renal hyperparathyroidism: analysis of 161 patients undergoing reoperative parathyroidectomy. World J Surg, 2013, 37(9): 2155-2161.
41. 段梦莲, 陈创, 孙圣荣. 50例尿毒症继发性甲状旁腺功能亢进患者的手术疗效分析. 中国普外基础与临床杂志, 2019, 26(1): 61-66.
42. La Manna G. Parathyroidectomy before or after transplantation: a dilemma still open! Artif Organs, 2018, 42(2): 127-130.
43. Delos Santos R, Rossi A, Coyne D, et al. Management of post-transplant hyperparathyroidism and bone disease. Drugs, 2019, 79(5): 501-513.
44. Gwinner W, Suppa S, Mengel M, et al. Early calcification of renal allografts detected by protocol biopsies: causes and clinical implications. Am J Transplant, 2005, 5(8): 1934-1941.
45. Bouquegneau A, Salam S, Delanaye P, et al. Bone disease after kidney transplantation. Clin J Am Soc Nephrol, 2016, 11(7): 1282-1296.
46. Jeon HJ, Kim YJ, Kwon HY, et al. Impact of parathyroidectomy on allograft outcomes in kidney transplantation. Transpl Int, 2012, 25(12): 1248-1256.
47. Littbarski SA, Kaltenborn A, Gwiasda J, et al. Timing of parathyroidectomy in kidney transplant candidates with secondary hyperparathryroidism: effect of pretransplant versus early or late post-transplant parathyroidectomy. Surgery, 2018, 163(2): 373-380.
48. Tseng PY, Yang WC, Yang CY, et al. Long-term outcomes of parathyroidectomy in kidney transplant recipients with persistent hyperparathyroidism. Kidney Blood Press Res, 2015, 40(4): 386-394.
49. Callender GG, Malinowski J, Javid M, et al. Parathyroidectomy prior to kidney transplant decreases graft failure. Surgery, 2017, 161(1): 44-50.
50. Hod T, Riella LV, Chandraker A. Recombinant PTH therapy for severe hypoparathyroidism after kidney transplantation in pre-transplant parathyroidectomized patients: review of the literature and a case report. Clin Transplant, 2015, 29(11): 951-957.
51. Evenepoel P, Claes K, Kuypers D, et al. Impact of parathyroidectomy on renal graft function, blood pressure and serum lipids in kidney transplant recipients: a single centre study. Nephrol Dial Transplant, 2005, 20(8): 1714-1720.
52. Chen HM, Dai JJ, Zhu R, et al. Parathyroid hormone-related protein induces fibronectin up-regulation in rat mesangial cells through reactive oxygen species/Src/EGFR signaling. Biosci Rep, 2019, 39(4): BSR20182293.
53. Evenepoel P, Claes K, Kuypers DR, et al. Parathyroidectomy after successful kidney transplantation: a single centre study. Nephrol Dial Transplant, 2007, 22(6): 1730-1737.

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Actualities in surgical treatment of uremic secondary hyperparathyroidism

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