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

Abstract

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

Parathyroidectomy for the treatment of hyperparathyroidism: Thirty‐day morbidity and mortality

“…Preoperative lab values indicate that 2HPT patients have markers indicating poorer renal function. It is also well known that 2HPT is associated with increased cardiovascular mortality . Ishani et al specifically studied dialysis patients with 2HPT and noted a pronounced association between PTX and increased hospitalizations, intensive care unit admission, duration of hospitalization, and emergency department visits.…”

“…It is also well known that 2HPT is associated with increased cardiovascular mortality. 33 Ishani et al 34 specifically studied dialysis patients with 2HPT and noted a pronounced association between PTX and increased hospitalizations, intensive care unit admission, duration of hospitalization, and emergency department visits. During the hospitalization and the 30 days immediately after discharge, the mortality rate was 2.0%.…”

Calcitriol loading before total parathyroidectomy with autotransplant in patients with end‐stage kidney disease: does it prevent postoperative hypocalcaemia?

“…A recent meta-analysis by Chen et al demonstrated that parathyroidectomy reduced all-cause mortality in haemodialysis patients by 28%. 25,26 Although HBS is an undesirable consequence of parathyroidectomy, in our study the HBS group were more likely to achieve PTH normalisation (4.49 vs 11.75 pmol/L, P = 0.021). These patients may confer mortality benefit due to reduced vascular calcification and cardiovascular events in the long term.…”

Risk factors associated with subendocardial ischemia in hemodialysis patients

“…Despite of fact that microvascular dysfunction was no reverted after PTX, recent systematic review and meta-analysis demonstrated that PTX was associated with decreased risks of all-cause and cardiovascular mortalities compared to medical treatments in CKD patients with SHPT. 9 In conclusion, paper from Silva et al is really welcome. It is important to highlight that our understanding of the cardiovascular manifestations of SHPT remains still incomplete.…”