BACKGROUND: Severe secondary hyperparathyroidism, which is associated with life-threatening complications, can develop in dialysis-dependent end-stage renal disease patients. The aim of this study was to compare short- and long-term mortality in dialysis patients who underwent near-total parathyroidectomy (NTPTX) and matched nonoperated controls. STUDY DESIGN: We identified 150 dialysis patients who underwent NTPTX (1993-2009) at our institution and compared them with 1,044 nonoperated control patients identified in the US Renal Data System registry, matched for age, sex, race, diabetes as cause of kidney failure, years on dialysis, and dialysis modality. Survival outcomes were estimated using multivariable Cox proportional hazards models with stratification on the matching sets, adjusted for cardiovascular comorbidities, smoking, inability to ambulate/transfer, and payor status. RESULTS: During a follow-up of a mean of 3.6 years (range 0.1 month to 16.4 years), NTPTX patients had a significant reduction in the long-term risk of all-cause death (hazard ratio = 0.68; 95% CI, 0.52-0.89; p = 0.006) compared with controls. Thirty-day mortality rates for NTPTX patients and controls were 246 vs 105 per 1,000 person-years (p = 0.21). In adjusted analyses, NTPTX patients had a 37% reduced risk of all-cause death and a 33% reduced risk of cardiovascular death compared with controls. A durable reduction in mean parathyroid hormone was observed after NTPTX; from 1,776 ± 1,416.6 pg/mL to 301 ± 285.7 pg/mL (p < 0.0001). CONCLUSIONS: In our center, NTPTX in dialysis patients was associated with a significant reduction in long-term risk of death compared with matched control patients, without a significantly increased short-term risk.
BACKGROUND: Severe secondary hyperparathyroidism, which is associated with life-threatening complications, can develop in dialysis-dependent end-stage renal diseasepatients. The aim of this study was to compare short- and long-term mortality in dialysis patients who underwent near-total parathyroidectomy (NTPTX) and matched nonoperated controls. STUDY DESIGN: We identified 150 dialysis patients who underwent NTPTX (1993-2009) at our institution and compared them with 1,044 nonoperated control patients identified in the US Renal Data System registry, matched for age, sex, race, diabetes as cause of kidney failure, years on dialysis, and dialysis modality. Survival outcomes were estimated using multivariable Cox proportional hazards models with stratification on the matching sets, adjusted for cardiovascular comorbidities, smoking, inability to ambulate/transfer, and payor status. RESULTS: During a follow-up of a mean of 3.6 years (range 0.1 month to 16.4 years), NTPTXpatients had a significant reduction in the long-term risk of all-cause death (hazard ratio = 0.68; 95% CI, 0.52-0.89; p = 0.006) compared with controls. Thirty-day mortality rates for NTPTXpatients and controls were 246 vs 105 per 1,000 person-years (p = 0.21). In adjusted analyses, NTPTXpatients had a 37% reduced risk of all-cause death and a 33% reduced risk of cardiovascular death compared with controls. A durable reduction in mean parathyroid hormone was observed after NTPTX; from 1,776 ± 1,416.6 pg/mL to 301 ± 285.7 pg/mL (p < 0.0001). CONCLUSIONS: In our center, NTPTX in dialysis patients was associated with a significant reduction in long-term risk of death compared with matched control patients, without a significantly increased short-term risk.
Authors: Robert N Foley; Suying Li; Jiannong Liu; David T Gilbertson; Shu-Cheng Chen; Allan J Collins Journal: J Am Soc Nephrol Date: 2004-11-24 Impact factor: 10.121
Authors: Anthony J Bleyer; John Burkart; Michael Piazza; Gregory Russell; Michael Rohr; J Jeffrey Carr Journal: Am J Kidney Dis Date: 2005-09 Impact factor: 8.860
Authors: K R Neves; F G Graciolli; L M dos Reis; R G Graciolli; C L Neves; A O Magalhães; M R Custódio; D G Batista; V Jorgetti; R M A Moysés Journal: Kidney Int Date: 2007-04-04 Impact factor: 10.612
Authors: Jürgen Floege; Joseph Kim; Elizabeth Ireland; Charles Chazot; Tilman Drueke; Angel de Francisco; Florian Kronenberg; Daniele Marcelli; Jutta Passlick-Deetjen; Guntram Schernthaner; Bruno Fouqueray; David C Wheeler Journal: Nephrol Dial Transplant Date: 2010-04-25 Impact factor: 5.992