The Risk of Peripheral Arterial Disease after Parathyroidectomy in Patients with End-Stage Renal Disease

Abstract

PurposeThe changes of the risk of peripheral arterial disease (PAD) in patients with end-stage renal disease after parathyroidectomy are scant.MethodsWe used a nationwide health insurance claims database to select all dialysis-dependent patients with end-stage renal disease aged 18 years and older for the study population in 2000 to 2006. Of the patients with end-stage renal disease, we selected 947 patients who had undergone parathyroidectomy as the parathyroidectomy group and frequency matched 3746 patients with end-stage renal disease by sex, age, years since the disease diagnosis, and the year of index date as the non-parathyroidectomy group. We used a multivariate Cox proportional hazards regression analysis with the use of a robust sandwich covariance matrix estimate, accounting for the intra-cluster dependence of hospitals or clinics, to measure the risk of peripheral arterial disease for the parathyroidectomy group compared with the non-parathyroidectomy group after adjusting for sex, age, premium-based income, urbanization, and comorbidity.ResultsThe mean post-op follow-up periods were 5.08 and 4.52 years for the parathyroidectomy and non-parathyroidectomy groups, respectively; the incidence density rate of PAD in the PTX group was 12.26 per 1000 person-years, significantly lower than the data in the non-PTX group (24.09 per 1000 person-years, adjusted HR = 0.66, 95% CI = 0.46–0.94).ConclusionParathyroidectomy is associated with reduced risk of peripheral arterial disease in patients with end-stage renal disease complicated with severe secondary hyperparathyroidism.

Association between 25-hydroxyvitamin D and abdominal aortic calcification in US adults: Findings From NHANES 2013-2014

“…CaMOS (Canadian Multi-center Osteoporosis Study) showed that older female calcium supplement users had signi cantly more rapid AAC progression over 5 years [33]. Recent studies have shown that after parathyroidectomy, the calcium level of patients with end-stage renal disease fell dramatically and calci cation progression slowed down [34]. The results of our study are similar, suggesting that calcium metabolism may be directly related to AAC.…”

Targeted surgical parathyroidectomy in end‐stage renal disease patients and long‐term metabolic control: A single‐center experience in the current era

“…15,16 PTX reduces mortality in ESRD [17][18][19] and appears cost-effective beyond 7 months or so. 20 Further, PTX decreases the risk of hip fractures 21 and stroke 22 and may decrease the burden of peripheral vascular disease 23 in ESRD patients while improving their overall quality of life. 24 Surgical techniques and approaches, however, are not equal.…”

Treatment for secondary hyperparathyroidism focusing on parathyroidectomy

“…Similarly, in the PTx group, the allcause mortality was superior to that in the non-PTx group according to the propensity score matching analysis of the United States Renal Data System data (8). Additionally, the effects of PTx in improving anemia, insomnia, cognitive status, peripheral arterial disease, and blood pressure have been demonstrated (142)(143)(144)(145)(146). The cost-effectiveness of PTx compared with medical treatment in patients eligible for PTx was also demonstrated (2,37).…”