ABSTRACT Background The utility of intraoperative parathyroid hormone (IOPTH) monitoring during subtotal parathyroidectomy to predict long‐term intact PTH levels in kidney failure remains uncertain. Methods Diagnostic accuracy study in a cohort of 46 patients with severe, uncontrolled secondary hyperparathyroidism. IOPTH was measured before incision and at 10‐ and 30‐min post‐excision. Sensitivity, specificity, and AUC‐ROC were assessed for predicting surgical success—defined as iPTH < 300 pg/mL (KDOQI criterion) over 6 months. We also assessed KDIGO criterion as secondary outcome (iPTH < 9× the upper limit of normal, defined as 792 pg/mL) All patients received postoperative calcium and active vitamin D. Results Surgical success was achieved in 37 (80%) patients using the KDOQI criterion. Compared with the failure group, the KDOQI success group had lower median 10‐min IOPTH (186 pg/mL vs. 495 pg/mL, p < 0.001) and 30‐min IOPTH (112 pg/mL vs. 495 pg/mL, p < 0.001). The 10‐min percentage decline in IOPTH was also greater in patients who experienced KDOQI success (91% vs. 85%, p = 0.008). AUCs for 10‐ and 30‐min IOPTH in predicting KDOQI success were 0.86 (95% CI: 0.72–1.00) and 0.86 (95% CI: 0.73–1.00), respectively. AUCs for percentage decline at 10 and 30 min were 0.78 (95% CI: 0.63–0.92, p = 0.03) and 0.75 (95% CI: 0.60–0.92, p = 0.02), respectively. A 10‐min IOPTH < 270.7 pg/mL yielded 89% sensitivity and 68% specificity for predicting KDOQI success. Using KDIGO criterion, 41 (89%) patients achieved surgical success, with similar trends observed. Conclusions In severe secondary hyperparathyroidism due to kidney failure, 10‐min IOPTH is a strong predictor of surgical success, with < 270 pg/mL suggesting better outcomes; percentage decline and 30‐min values add little benefit.
Ramírez‐Sandoval et al. (Thu,) studied this question.