Parathyroidectomy and patient survival in CKD patients.

We hereby declare that the content of this editorial has not been published previously in whole or part. received lecture fees from Pharmacosmos. (See related article by Fishbane et al. Ferric pyrophosphate cit-rate (Triferic™) administration via the dialysate maintains hemoglobin and iron balance in chronic hemodialysis patients. 1. Padhi S, Glen J, Pordes BA et al. Management of anaemia in chronic kidney disease: summary of updated NICE guidance. BMJ 2015; 350: h2258 2. Drueke TB, Locatelli F, Clyne N et al. Normalization of hemoglobin level in patients with chronic kidney disease and anemia. Understanding iron: promoting its safe use in patients with chronic kidney failure treated by hemodialysis. A et al. Dialysate iron therapy: infusion of soluble ferric pyrophosphate via the dialysate during hemodialysis. Data from the Dialysis Outcomes and Practice Patterns Study validate an association between high intravenous iron doses and mortality. Effect of intravenous iron use on hospitalizations in patients undergoing hemodialysis: a comparative effectiveness analysis from the DEcIDE-ESRD study. Secondary hyperparathyroidism (SHP) in patients with chronic kidney disease (CKD) is recognized as a key player in most of the adverse outcomes observed in this clinical setting [1, 2]. Until not much later than a decade ago, the therapy available for SHP control was limited and of relatively low efficacy, so that the indication to parathyroidectomy (PTX) remained high up to the beginning of the present century [3, 4]. More recently, an astonishing increase in new medical tools available to control SHP has translated into an improved control of biochemical parameters, with a progressive reduction in the use of PTX [5]. Despite a better biochemical control of SHP, no evidence has been produced of a positive impact of any of these new treatments on mortality [6, 7]. In view of the fact that the cost of these new medical therapies is far higher than PTX [8, 9], the critical question of which of the two strategies, the medical or the surgical therapeutic approach, is more cost effective remains of critical relevance. That being said, any new scientifically appropriate data that could add information in this field are welcome. In this issue of NDT, Ivarsson et al. [10] analysed the Swedish Renal Registry to explore the impact of PTX on