Parathyroidectomy and survival among Japanese hemodialysis patients with secondary hyperparathyroidism

Abstract

Parathyroidectomy (PTx) drastically improves biochemical parameters and clinical symptoms related to severe secondary hyperparathyroidism (SHPT) but the effect of PTx on survival has not been adequately investigated. Here we analyzed data on 114,064 maintenance hemodialysis patients from a nationwide registry of the Japanese Society for Dialysis Therapy to evaluate the associations of severity of SHPT and history of PTx with 1-year all-cause and cardiovascular mortality. We then compared the mortality rate between 4428 patients who had undergone PTx and 4428 propensity score-matched patients who had not despite severe SHPT. During a 1-year follow-up, 7926 patients of the entire study population died, of whom 3607 died from cardiovascular disease. Among patients without a history of PTx, severe SHPT was associated with an increased risk for all-cause and cardiovascular mortality. However, such an increased risk of mortality was not observed among patients with a history of PTx. In the propensity score-matched analysis, patients who had undergone PTx had a 34% and 41% lower risk for all-cause and cardiovascular mortality, respectively, compared to the matched controls. The survival benefit associated with PTx was robust in several sensitivity analyses and consistent across subgroups, except for those who had persistent postoperative SHPT. Thus, successful PTx may reduce the risk for all-cause and cardiovascular mortality in hemodialysis patients with severe, uncontrolled SHPT.

Rates and Outcomes of Parathyroidectomy for Secondary Hyperparathyroidism in the United States

“…Moreover, Komaba et al (26) studied the effect of parathyroidectomy on survival in patients with severe sHPT. They compared mortality among patients who underwent parathyroidectomy and propensity score-matched patients who did not undergo parathyroidectomy, despite severe sHPT, and suggested that parathyroidectomy reduced the risk for all-cause and cardiovascular mortality in patients with severe sHPT (26).…”

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

“…Of them, 37 studies were retrieved for detailed evaluation, and finally 24 studies were excluded due to absence of information on the outcomes of interest (19 articles) or provision of data only in abstract form (5 articles). Finally, 13 studies [19][20][21][22][23][24][25][26][27][28][29][30][31] fulfilled the eligibility criteria ( Figure 1), with 10052 PTx-treated patients and 12001 medically-treated patients (totally 22053 patients). The 13 studies were all cohort studies with sample sizes from 20 to 4558 patients, and reported prevalence rates of diabetes from 0% to 44.3%.…”

“…Most studies adjusted a wide range of potential confounders to investigate the association between PTx and all-cause mortality, including age, sex, body mass index (BMI), diabetes, duration of dialysis, and dialysis modality. Twelve studies presented data with all-cause mortality [19][20][21][22][23][24][25][26][27][28][29]31 and six studies with cardiovascular mortality. 19,20,23,26,28,30 Table 1 lists the key characteristics of the 13 studies.…”

“…We examined the 11 trials [19][20][21][22][23][24][25][26]28,29,31 that investigated the effect of PTx versus medical treatment on mortality against follow-up duration (<36 vs. 36 months). In the six trials with follow-up duration <36 months, the mortality rates are significantly different between PTxtreated and medically-treated patients (Figure 4).…”

Parathyroidectomy or Calcimimetic to Treat Hypercalcemia after Kidney Transplantation?

“…The long-term effects of cinacalcet therapy on hard outcomes in kidney transplant recipients are unknown at present. As to parathyroidectomy, a recent observational study reported that it was associated with improved survival in patients on maintenance dialysis, which was also shown by one of us before 13 but not in patients with a renal allograft. 14 Another issue lacking consensus is the relative merit of subtotal compared with total parathyroidectomy.…”