Effects of a parathyroidectomy on the immune system and nutritional condition in chronic dialysis patients with secondary hyperparathyroidism

Yasunaga, Chikao; Nakamoto, Masahiko; Matsuo, Kenzo; Nishihara, Gakusen; Yoshida, Tetsuhiko; Goya, Tadanobu

doi:10.1016/s0002-9610(99)00194-4

Cited by 39 publications

(23 citation statements)

References 25 publications

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“…6,24 Consistent with this hypothesis are reports documenting improvement in muscle strength and measured nutritional parameters among dialysis patients after PTX. [25][26][27] The association of PTX with lower fracture risk in this study is interesting given previously described associations of very low PTH levels with reduced BMD, adynamic bone disease, and a higher risk for fracture among long-term hemodialysis patients. 1,13,14,17,28 It is possible that previous associations represent residual confounding by unmeasured characteristics of dialysis patients who have lower PTH levels and not specific effects of inadequate circulating PTH levels on bone.…”

Section: Discussionmentioning

confidence: 55%

Fracture Risk after Parathyroidectomy among Chronic Hemodialysis Patients

Rudser

Boer

Dooley³

et al. 2007

Journal of the American Society of Nephrology

158

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The impact of parathyroidectomy (PTX) on the long-term risks for hip and other fractures is unknown. Uncontrolled case series have reported an increase in bone mineral density after PTX. However, very low serum parathyroid hormone levels have been associated with decreased bone mineral density, adynamic bone disease, and fractures. This study compared long-term fracture rates among hemodialysis patients who underwent PTX with a matched control group. Data were obtained from the US Renal Data System. Patients who underwent a first PTX while receiving hemodialysis were matched with up to three control patients by age, race, gender, year of dialysis initiation, primary cause of renal failure, and the dosage of intravenous vitamin D used before PTX. Patients with a history of fracture or renal transplantation were excluded. Study outcomes were incident hip, vertebral, and distal radius-wrist fractures identified using hospitalization codes. Incident hip fracture rates in the PTX and matched control groups were 6.0 and 9.3 fractures per 1000 person-years, respectively. After adjustment, PTX was associated with a significant 32% lower risk for hip fracture (95% confidence interval 0.54 to 0.86; P ϭ 0.001) and a 31% lower risk for any analyzed fracture (95% confidence interval 0.57 to 0.83; P Ͻ 0.001) compared with matched control subjects. Fracture risks were lower among hemodialysis patients who underwent PTX compared with matched control subjects. Surgical amelioration of secondary hyperparathyroidism may outweigh the risk of parathyroid hormone oversuppression in terms of bone health.

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Section: Discussionmentioning

confidence: 55%

Fracture Risk after Parathyroidectomy among Chronic Hemodialysis Patients

Rudser

Boer

Dooley³

et al. 2007

Journal of the American Society of Nephrology

158

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“…Moreover, left ventricular function in patients with advanced sHPT and dilated cardiomyopathy was markedly improved by PTx. 40 Other possible mechanisms for post-PTx survival improvement include reduction in fracture risk; 41 improvement in anemia and hypertension, 42 cardiac autonomic nervous system, 43 life-threatening condition of calciphylaxis, 44 immune system, 45 muscle strength, 46 as well as sustained reduction in fibroblast growth factor 23.…”

Section: Discussionmentioning

confidence: 99%

Long–term mortality after parathyroidectomy among chronic kidney disease patients with secondary hyperparathyroidism: a systematic review and meta-analysis

Chen

Wang

et al. 2016

Renal Failure

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Parathyroidectomy (PTx) and medical treatments are both recommended for reducing serum intact parathyroid hormone (iPTH) and curing secondary hyperparathyroidism (sHPT) in patients with chronic kidney disease (CKD), but their therapeutic effects on long-term mortality are not well-known. Thus, we aim to assess such therapeutic effect of PTx. Electronic literatures published on Pubmed, Embase, and Cochrane Central Register of Controlled Trials in any language until 27 November 2015 were systematically searched. All literatures that compared outcomes (survival rate or mortality rate) between PTx-treated and medically-treated CKD patients with sHPT were included. Finally, 13 cohort studies involving 22053 patients were included. Data were extracted from all included literatures in a standard form. The outcomes of all-cause and cardiovascular mortalities were assessed using DerSimonian and Laird's random effects model. We find PTx-treated versus medically-treated patients had a 28% reduction in all-cause mortality and a 37% reduction in cardiovascular mortality. Thus, PTx versus medical treatments might reduce the risks of all-cause and cardiovascular mortalities in CKD patients with sHPT. Further studies with prospective and large-sample clinical trials are needed to find out the real effect of PTx and to assess whether mortality rates differ among patterns of PTx. ARTICLE HISTORY

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“…Nevertheless, treatment with the aim of achieving pharmacological control of parathormone secretion should be seriously considered in such patients in the early phase of renal insufficiency. PTX appears to improve high blood pressure, anemia, nutritional deficiencies, immunity, glucose and lipid metabolism, muscle strength and the quality of life, while also relieving insomnia and even increasing the cognitive function (21)(22)(23)(24)(25). The mechanisms responsible for the remarkable beneficial effects of PTX have not been identified; however, a dramatic reduction in the PTH level and improved control of the serum mineral levels are certainly involved.…”

Section: Discussionmentioning

confidence: 99%

Dramatic Alteration of the Skull in a Uremic Patient with Leontiasis Ossea

et al. 2014

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The craniofacial skeleton represents a peculiar target of hyperparathyroidism in patients with end-stage renal disease who exhibit a dramatic pattern of uremic leontiasis ossea. Scant information regarding this condition is available in the renal literature, as the extreme and typical manifestations of leontiasis ossea have been described in only a small series of patients. We herein report a case of significant amelioration of massive modification of the facial appearance of a 30-year-old uremic Chinese woman with severe skeletal deformities who underwent total parathyroidectomy with a forearm autograft concurrently with effective drug treatment. This report may shed light on how to better understand and treat this metabolic derangement.

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Effects of a parathyroidectomy on the immune system and nutritional condition in chronic dialysis patients with secondary hyperparathyroidism

Cited by 39 publications

References 25 publications

Fracture Risk after Parathyroidectomy among Chronic Hemodialysis Patients

Fracture Risk after Parathyroidectomy among Chronic Hemodialysis Patients

Long–term mortality after parathyroidectomy among chronic kidney disease patients with secondary hyperparathyroidism: a systematic review and meta-analysis

Dramatic Alteration of the Skull in a Uremic Patient with Leontiasis Ossea

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