Parathyroidectomy Is Associated with Reduced Mortality in Hemodialysis Patients with Secondary Hyperparathyroidism

Abstract

Secondary hyperparathyroidism increases morbidity and mortality in hemodialysis patients. The Kidney Disease Outcomes Quality Initiative Guidelines recommend parathyroidectomy for patients with chronic kidney disease and parathyroid hormone concentrations exceeding 800 pg/mL; however, this concentration represents an arbitrary cut-off value. The present study was conducted to identify factors influencing mortality in hemodialysis patients with parathyroid hormone concentrations exceeding 800 pg/mL and to evaluate the effects of parathyroidectomy on outcome for these patients. Two hundred twenty-one hemodialysis patients with parathyroid hormone concentrations > 800 pg/mL from July 2004 to June 2010 were identified. 21.1% of patients (n = 60) received parathyroidectomy and 14.9% of patients (n = 33) died during a mean follow-up of 36 months. Patients with parathyroidectomy were found to have lower all-cause mortality (adjusted hazard ratio [aHR]: 0.34). Other independent predictors included age ≥ 65 years (aHR: 2.11) and diabetes mellitus (aHR: 3.80). For cardiovascular mortality, parathyroidectomy was associated with lower mortality (HR = 0.31) but with a marginal statistical significance (p = 0.061). In multivariate analysis, diabetes was the only significant predictor (aHR: 3.14). It is concluded that, for hemodialysis patients with parathyroid hormone concentrations greater than 800 pg/mL, parathyroidectomy is associated with reduced all-cause mortality.

Survival after parathyroidectomy in chronic hemodialysis patients with severe secondary hyperparathyroidism

“…It demonstrated that 1-year mortality rate was significantly higher among patients without a history of PTX comparing with those with a history of PTX [12]. Even if shortterm mortality, mostly in immediate postoperative period, was increased, decreased long-term mortality was the main result in other studies [8,13]. Trombetti et al [14] suggest that the survival advantage of patients after PTX is because healthier patients with fewer comorbidities are selected for the intervention.…”

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).…”

Paratireoidectomia na doença renal crônica: efeitos no ganho de peso e na melhora da qualidade de vida

“…When quality of life becomes much compromised, the deformities are important and the bone pain intractable, surgery becomes the best option. In general, total parathyroidectomy with a forearm implant has been an excellent therapeutic option, reversing these negative factors 10 . The objective of this study was to evaluate the benefit of parathyroidectomy (PTx) on quality of life, body weight, biochemical and metabolic parameters in dialytic chronic renal disease.…”