The Value of Clinical-ultrasonographic Feature Model to Predict the Severity of Secondary Hyperparathyroidism

Overview

Journal Ren Fail

Publisher Informa Healthcare

Date 2022 Feb 15

PMID 35164637

Authors

Xiaoer Zhang

Wenxin Xu

Tongyi Huang

Jingzhi Huang

Chunyang Zhang

Yutong Zhang

Xiaoyan Xie

Ming Xu

Affiliations

Soon will be listed here.

Abstract

Objectives: To analyze conventional ultrasound (CUS) and contrast-enhanced ultrasound (CEUS) features in patients with secondary hyperparathyroidism (SHPT) and to evaluate the clinical-ultrasonographic feature based model for predicting the severity of SHPT.

Methods: From February 2016 to March 2021, a total of 59 patients (age 51.3 ± 11.7 years, seCr 797.8 ± 431.7 μmol/L, iPTH 1535.1 ± 1063.9 ng/L) with SHPT (including 181 parathyroid glands (PTGs)) without the history of intact parathyroid hormone (iPTH)-reducing drugs using were enrolled. The patients were divided into the mild SHPT group (mSHPT, iPTH <800 ng/L) and the severe SHPT group (sSHPT, iPTH ≥ 800 ng/L) according to the serum iPTH level. The clinical test data of patients were collected and CUS and CEUS examinations were performed for every patient. Multivariable logistic regression model according to clinical-ultrasonographic features was adopted to establish a nomogram. We performed K-fold cross-validation on this nomogram model and nomogram performance was determined by its discrimination, calibration, and clinical usefulness.

Results: There were 19 patients in the mSHPT group and 40 patients in the sSHPT group. Multivariable logistic regression indicated serum calcium, serum phosphorus and total volume of PTGs were independent predictors related with serum iPTH level. Even though CEUS score of wash-in and wash-out were showed related to severity of SHPT in univariate logistic regression analysis, they were not predictors of SHPT severity ( = 0.539, 0.474 respectively). The nomogram developed by clinical and ultrasonographic features showed good calibration and discrimination. The accuracy and the area under the curve (AUC), positive predictive value (PPV), negative predictive value (NPV) and accuracy of this model were 0.888, 92.5%, 63.2% and 83.1%, respectively. When applied to internal validation, the score revealed good discrimination with stratified fivefold cross-validation in the cohort (mean AUC = 0.833).

Conclusions: The clinical-ultrasonographic features model has good performance for predicting the severity of SHPT.

References

Reiss A, Miyawaki N, Moon J, Kasselman L, Voloshyna I, DAvino Jr R . CKD, arterial calcification, atherosclerosis and bone health: Inter-relationships and controversies. Atherosclerosis. 2018; 278:49-59. DOI: 10.1016/j.atherosclerosis.2018.08.046. View

Qin X, Wang B, Li B, Lin C, Liu X, Xie X . Value of contrast-enhanced ultrasonography in radiofrequency ablation of secondary hyperparathyroidism. Ren Fail. 2021; 43(1):445-451. PMC: 7939554. DOI: 10.1080/0886022X.2021.1889601. View

Wan J, Li W, Zhong Y . Parathyroidectomy decreases serum intact parathyroid hormone and calcium levels and prolongs overall survival in elderly hemodialysis patients with severe secondary hyperparathyroidism. J Clin Lab Anal. 2018; 33(3):e22696. PMC: 6818588. DOI: 10.1002/jcla.22696. View

Komaba H, Ketteler M, Cunningham J, Fukagawa M . Old and New Drugs for the Management of Bone Disorders in CKD. Calcif Tissue Int. 2021; 108(4):486-495. DOI: 10.1007/s00223-020-00788-y. View

Yuan L, Kan Y, Ma D, Yang J . Combined application of ultrasound and SPECT/CT has incremental value in detecting parathyroid tissue in SHPT patients. Diagn Interv Imaging. 2015; 97(2):219-25. DOI: 10.1016/j.diii.2015.08.007. View

Meola M, Petrucci I, Cupisti A . Ultrasound in clinical setting of secondary hyperparathyroidism. J Nephrol. 2012; 26(5):848-55. DOI: 10.5301/jn.5000219. View

Indridason O, Heath 3rd H, Khosla S, Yohay D, Quarles L . Non-suppressible parathyroid hormone secretion is related to gland size in uremic secondary hyperparathyroidism. Kidney Int. 1996; 50(5):1663-71. DOI: 10.1038/ki.1996.483. View

Gooding G, Clark O . Use of color Doppler imaging in the distinction between thyroid and parathyroid lesions. Am J Surg. 1992; 164(1):51-6. DOI: 10.1016/s0002-9610(05)80645-2. View

Drueke T . Cell biology of parathyroid gland hyperplasia in chronic renal failure. J Am Soc Nephrol. 2000; 11(6):1141-1152. DOI: 10.1681/ASN.V1161141. View

10.

Rodriguez-Ortiz M, Pendon-Ruiz de Mier M, Rodriguez M . Parathyroidectomy in dialysis patients: Indications, methods, and consequences. Semin Dial. 2019; 32(5):444-451. DOI: 10.1111/sdi.12772. View

11.

Estepa J, Aguilera-Tejero E, Lopez I, Almaden Y, Rodriguez M, Felsenfeld A . Effect of phosphate on parathyroid hormone secretion in vivo. J Bone Miner Res. 1999; 14(11):1848-54. DOI: 10.1359/jbmr.1999.14.11.1848. View

12.

Calliada F, SALA G, Conti M, Corsi G, Oldini C, Bottinelli O . [Clinical applications of color-Doppler: the parathyroid glands]. Radiol Med. 1993; 85(5 Suppl 1):114-9. View

13.

de Francisco A, Cobo M, Setien M, Rodrigo E, Fresnedo G, Unzueta M . Effect of serum phosphate on parathyroid hormone secretion during hemodialysis. Kidney Int. 1998; 54(6):2140-5. DOI: 10.1046/j.1523-1755.1998.00221.x. View

14.

Li X, Li J, Li Y, Wang H, Yang J, Mou S . The role of preoperative ultrasound, contrast-enhanced ultrasound, and 99mTc-MIBI scanning with single-photon emission computed tomography/X-ray computed tomography localization in refractory secondary hyperparathyroidism. Clin Hemorheol Microcirc. 2019; 75(1):35-46. DOI: 10.3233/CH-190723. View

15.

Salem M . Hyperparathyroidism in the hemodialysis population: a survey of 612 patients. Am J Kidney Dis. 1997; 29(6):862-5. DOI: 10.1016/s0272-6386(97)90459-5. View

16.

Kakani E, Sloan D, Sawaya B, El-Husseini A, Malluche H, Rao M . Long-term outcomes and management considerations after parathyroidectomy in the dialysis patient. Semin Dial. 2019; 32(6):541-552. DOI: 10.1111/sdi.12833. View

17.

Vulpio C, Bossola M, de Gaetano A, Maresca G, Di Stasio E, Spada P . Ultrasound patterns of parathyroid glands in chronic hemodialysis patients with secondary hyperparathyroidism. Am J Nephrol. 2008; 28(4):589-97. DOI: 10.1159/000116875. View

18.

Komaba H, Kakuta T, Fukagawa M . Management of secondary hyperparathyroidism: how and why?. Clin Exp Nephrol. 2017; 21(Suppl 1):37-45. DOI: 10.1007/s10157-016-1369-2. View

19.

Hasegawa H, Nagano N, Urakawa I, Yamazaki Y, Iijima K, Fujita T . Direct evidence for a causative role of FGF23 in the abnormal renal phosphate handling and vitamin D metabolism in rats with early-stage chronic kidney disease. Kidney Int. 2010; 78(10):975-80. DOI: 10.1038/ki.2010.313. View

20.

Rodriguez M, Salmeron M, Martin-Malo A, Barbieri C, Mari F, Molina R . A New Data Analysis System to Quantify Associations between Biochemical Parameters of Chronic Kidney Disease-Mineral Bone Disease. PLoS One. 2016; 11(1):e0146801. PMC: 4726537. DOI: 10.1371/journal.pone.0146801. View