The effect of parathyroidectomy compared to non-surgical surveillance on kidney function in primary hyperparathyroidism: a nationwide historic cohort study.

BACKGROUND: Patients with primary hyperparathyroidism (pHPT) and impaired kidney function (estimated glomerular filtration rate (eGFR) < 60 mL/min) are offered parathyroidectomy (PTX) to protect them from further complications. Surprisingly, two recent uncontrolled cohort studies have suggested a further decrease in kidney function following PTX. We aimed to examine the effects of PTX compared to non-surgical surveillance on kidney function in pHPT patients. METHODS: Historic cohort study. From the Danish National Patient Registry (NPR) and major medical biochemistry laboratories in Denmark, we identified 3585 patients with biochemically confirmed pHPT among whom n = 1977 (55%) were treated with PTX (PTX-group) whereas n = 1608 (45%) were followed without surgery (non-PTX group). Baseline was defined as time of diagnosis and kidney function was re-assessed 9-15 months after PTX (PTX group) or 9-15 months after diagnosis (non-PTX group). RESULTS: At follow-up, eGFR had decreased significantly in the PTX- compared to the non-PTX-group (median - 4% vs. - 1%, p < 0.01). Stratification by baseline eGFR showed that the decrease was significant for those with a baseline eGFR value of 80-89 and > 90 mL/min, but not for those with lower eGFR values. Findings did not differ between patients with mild compared to moderate/severe hypercalcemia. However, after mutual adjustments, we identified baseline levels of calcium, PTH, and eGFR as well as age and treatment (PTX vs. no-PTX) as independent predictors for changes in kidney function. CONCLUSION: Compared to non-surgical surveillance, PTX is associated with a small but significant decrease in kidney function in pHPT patients with an initial normal kidney function.

Non-skeletal health effects of vitamin D supplementation: A systematic review on findings from meta-analyses summarizing trial data.

BACKGROUND: A large number of observational studies have reported harmful effects of low 25-hydroxyvitamin D (25OHD) levels on non-skeletal outcomes. We performed a systematic quantitative review on characteristics of randomized clinical trials (RCTs) included in meta-analyses (MAs) on non-skeletal effects of vitamin D supplementation. METHODS AND FINDINGS: We identified systematic reviews (SR) reporting summary data in terms of MAs of RCTs on selected non-skeletal outcomes. For each outcome, we summarized the results from available SRs and scrutinized included RCTs for a number of predefined characteristics. We identified 54 SRs including data from 210 RCTs. Most MAs as well as the individual RCTs reported null-findings on risk of cardiovascular diseases, type 2 diabetes, weight-loss, and malignant diseases. Beneficial effects of vitamin D supplementation was reported in 1 of 4 MAs on depression, 2 of 9 MAs on blood pressure, 3 of 7 MAs on respiratory tract infections, and 8 of 12 MAs on mortality. Most RCTs have primarily been performed to determine skeletal outcomes, whereas non-skeletal effects have been assessed as secondary outcomes. Only one-third of the RCTs had low level of 25OHD as a criterion for inclusion and a mean baseline 25OHD level below 50 nmol/L was only present in less than half of the analyses. CONCLUSIONS: Published RCTs have mostly been performed in populations without low 25OHD levels. The fact that most MAs on results from RCTs did not show a beneficial effect does not disprove the hypothesis suggested by observational findings on adverse health outcomes of low 25OHD levels.

Prevalence of cancer in Danish patients referred to a fast-track diagnostic pathway is substantial.

INTRODUCTION: Danish patients diagnosed with cancer who present with unspecific signs and symptoms are diagnosed with unfavourable delay, which has led to the establishment of a national fast-track (cancer) pathway. The aim of this study was to estimate the prevalence of cancer and other diagnoses in patients referred to this programme at Aarhus University Hospital from general practitioners. Furthermore, we aimed to characterise the patient cohort, assess survival and estimate the predictive values of symptoms, signs and biochemical abnormalities. METHODS: From 1 March 2011 to 31 December 2013, data of interest were consecutively collected from the electronic patient record by two medical doctors. RESULTS: Overall, 18% (58/323) had cancer, but the prevalence decreased from 22% in 2011 to 16% in 2013. Haematological cancers and cancers originating from the digestive system were the predominant cancer diagnoses. Patients diagnosed with cancer unfortunately had a high mortality suggesting that we diagnose cancer in the late, non-curable stages. Patients referred to the fast-track pathway had a median of four symptoms, most commonly weight loss and fatigue. In one fourth of the patients, a final diagnosis was not reached at discharge. For the rest (n = 185), gastrointestinal conditions, infectious and rheumatological diseases were most common. The predictive value of the presenting symptoms was poor. Age and biochemical markers considered as unspecific markers of cancer were better predictors. Anaemia was seen in 71% versus 34% of patients with/without diagnosed cancer, respectively. CONCLUSIONS: Unspecific signs and symptoms that may be indicative of cancer represent a clinical challenge. A fast-track (cancer) pathway is a new option for patients not entitled to enter an organ-specific programme.