The effect of parathyroidectomy on patient survival in secondary hyperparathyroidism

Ivarsson, Kjell; Akaberi, Shahriar; Isaksson, Elin; Reihnér, Eva; Rylance, Rebecca; Prütz, Karl-Göran; Clyne, Naomi; Almquist, Martin

doi:10.1093/ndt/gfv334

Cited by 81 publications

(68 citation statements)

References 41 publications

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“…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%.…”

Section: Selection and Characteristics Of Studiesmentioning

confidence: 99%

“…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.…”

Section: Selection and Characteristics Of Studiesmentioning

confidence: 99%

“…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).…”

Section: Effect Of Ptx Versus Medical Treatments On Mortality Againstmentioning

confidence: 99%

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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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Section: Selection and Characteristics Of Studiesmentioning

confidence: 99%

Section: Selection and Characteristics Of Studiesmentioning

confidence: 99%

Section: Effect Of Ptx Versus Medical Treatments On Mortality Againstmentioning

confidence: 99%

See 1 more Smart Citation

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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“…PTX was associated with improved survival in patients on maintenance dialysis but not in patients with renal allograft. Moreover, PTX improves calcium and phosphate balance [11].…”

Section: Discussionmentioning

confidence: 98%

Predicting the Effect of Parathyroidectomy on Patient Survival in Secondary Hyperparathyroidism with Machine Learning

Oktoria¹,

Yang²,

Chen³

2017

IJPMBS

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“…Ivarsson et al [30] studied the effect of PTX on patient survival using the Swedish Renal Registry. Incident dialysis patients with PTX ( n = 423) were compared with non-PTX patients ( n = 1,234) and matched for gender, age, cause of ESRD.…”

Section: Discussionmentioning

confidence: 99%

Value of Intraoperative Parathyroid Hormone Assay during Parathyroidectomy in Dialysis and Renal Transplant Patients with Secondary and Tertiary Hyperparathyroidism

El-Husseini

Wang

Edon

et al. 2017

Nephron

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Background: In dialysis and renal transplant patients with secondary and tertiary hyperparathyroidism (HPT), the value of intraoperative parathyroid hormone (ioPTH) during parathyroidectomy (PTX) and its association with long-term PTH levels are unknown. The present study aims at evaluating the relationship of ioPTH with long-term PTH levels post-PTX in dialysis and renal transplant patients in a single-center study. Methods: The ioPTH was measured in 57 dialysis patients (33 females and 24 males) and 18 renal transplant recipients (12 males and 6 females) who underwent PTX from 2005 to 2015 for refractory HPT. Near-total PTX was performed in 56 patients and total PTX with autotransplantation in 20 patients. The PTH monitoring included 3 samples: pre-intubation, 10- and 20-min (pre-ioPTH, 10-ioPTH, and 20-ioPTH) post parathyroid gland excision. Patients were followed up for up to 5 years. Results: In the dialysis group, the median (25th–75th percentile) pre-, 10-, and 20-ioPTH levels were 1,447 pg/mL (938–2,176), 143 pg/mL (78–244) and 112 pg/mL (59–153) respectively. In the renal transplant group, pre-, 10-, and 20-ioPTH levels were 273 pg/mL (180–403), 42 pg/mL (25–72), and 34 pg/mL (23–45) respectively. All patients in the transplant group had a functional kidney transplant at the time of PTX with a median serum creatinine of 1.3 mg/dL (1.2–1.7) and estimated glomerular filtration rate of 55 mL/min (40–60). The median time between renal transplant and PTX surgeries was 22 months (7–81). The last median follow-up PTH level was 66 pg/mL (15–201) in the dialysis group and 54 pg/mL (17–72) in the transplant group (p = 0.438). The mean time for last PTH post-PTX was 2.3 ± 2.0 years. In both groups, there was no significant difference between 20-ioPTH and any-time post-PTX PTH levels (p = 0.6 and p = 0.9). Nineteen patients (25%) were readmitted within 90 days because of hypocalcemia. One patient in the dialysis group was readmitted for post-PTX hematoma evacuation. No patient required repeat PTX because of recurrent HPT that was refractory to medical therapy. Only one dialysis patient required repeat PTX because the first procedure failed. Conclusions: The 20-ioPTH is a good indicator of long-term PTH levels in dialysis and renal transplant patients. Hypocalcemia is a common complication, particularly in dialysis patients, and it is the main reason for readmission after PTX. Hypoparathyroidism is a potential concern after PTX in dialysis patients.

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The effect of parathyroidectomy on patient survival in secondary hyperparathyroidism

Abstract: PTX was associated with improved survival in patients on maintenance dialysis but not in patients with renal allograft.

Cited by 81 publications

References 41 publications

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

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

Predicting the Effect of Parathyroidectomy on Patient Survival in Secondary Hyperparathyroidism with Machine Learning

Value of Intraoperative Parathyroid Hormone Assay during Parathyroidectomy in Dialysis and Renal Transplant Patients with Secondary and Tertiary Hyperparathyroidism

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