Background
Secondary hyperparathyroidism (SHPT) and its associated abnormalities in mineral metabolism
increase the risk of cardiovascular morbidity and death in chronic renal failure (CRF).
The effect of parathyroidectomy (PTX) on the incidence of major cardiovascular events
in CRF patients with SHPT is unknown. We tested the hypothesis that PTX reduces the
incidence of cardiovascular complications and death in CRF patients with severe SHPT
scheduled for PTX, comparing the outcome of patients treated or not treated by PTX.
Methods
The study comprised 118 CRF patients with SHPT on maintenance hemodialysis, unresponsive
to medical treatment and scheduled for PTX. Patients underwent comprehensive cardiovascular
evaluations at baseline. They were followed up until death, occurrence of major cardiovascular
events, or kidney transplantation.
Results
No deaths related to PTX occurred. After a median follow-up of 30 months, 50 patients
(42%) had undergone PTX whereas 68 (58%) had not. The groups were comparable in terms
of age, sex, race, serum parathyroid hormone, calcium or phosphate, calcium x phosphate
product, and all major cardiovascular variables, except diastolic blood pressure.
PTX was associated with a reduced incidence of major cardiovascular events (P = .02) and overall mortality (P ≤ .001). Cox proportional multivariate analysis showed that variables associated
independently with events were No-PTX (RR = 2.36, CI 1.11-6.32, P = .02) and age (RR = 1.07, IC 1.02-1.14, P = .009). All-cause mortality was related to No-PTX (RR = 2.34, CI 1.25-5.14, P = .007) and hematocrit (RR = 1.15, CI 1.03-1.29, P = .01).
Conclusion
PTX confers protection against future major cardiovascular events and death in select
CRF patients with severe refractory SHPT.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Increased incidence of cardiovascular diseases in primary hyperparathyroidism—a cause for more aggressive treatment?.Eur J Clin Invest. 1998; 28: 277-278
- Increased risk of death from primary hyperparathyroidism—an update.Eur J Clin Invest. 1998; 28: 271-276
- Increased cardiovascular mortality and normalized serum calcium in patients with mild hypercalcemia followed up for 25 years.Surgery. 2001; 130: 978-985
- Association of elevated serum PO(4), Ca x PO(4) product, and parathyroid hormone with cardiac mortality risk in chronic hemodialysis patients.J Am Soc Nephrol. 2001; 12: 2131-2138
- Cohort study on effects of parathyroid surgery on multiple outcomes in primary hyperparathyroidism.BMJ. 2003; 327: 530-534
- Mortality in sporadic primary hyperparathyroidism: nationwide cohort study of multiple parathyroid gland disease.Surgery. 2004; 136: 981-987
- Correction of anemia with epoetin alfa in chronic kidney disease.N Engl J Med. 2006; 355: 2085-2098
- Primary hyperparathyroidism and heart disease—a review.Eur Heart J. 2004; 25: 1776-1787
- Outcome after surgery for primary hyperparathyroidism: ten-year prospective follow-up study.World J Surg. 2000; 24: 564-569
- Mortality after surgery for primary hyperparathyroidism: a follow-up of 441 patients operated on from 1956 to 1979.Surgery. 1987; 102: 1-7
- Survival after the diagnosis of hyperparathyroidism: a population-based study.Am J Med. 1998; 104: 115-122
- Association of serum phosphorus and calcium x phosphate product with mortality risk in chronic hemodialysis patients: a national study.Am J Kidney Dis. 1998; 31: 607-617
- Higher impact of mineral metabolism on cardiovascular mortality in a European hemodialysis population.Kidney Int Suppl. 2003; : S111-S114
- Predictors and consequences of altered mineral metabolism: the Dialysis Outcomes and Practice Patterns Study.Kidney Int. 2005; 67: 1179-1187
- The clinical consequences of secondary hyperparathyroidism: focus on clinical outcomes.Nephrol Dial Transplant. 2004; 19: v2-v8
- Clinical course after total parathyroidectomy without autotransplantation in patients with end-stage renal failure.Am J Kidney Dis. 1999; 33: 304-311
- Parathyroidectomy promotes wound healing and prolongs survival in patients with calciphylaxis from secondary hyperparathyroidism.Surgery. 2001; 130: 645-650
- Survival following parathyroidectomy among United States dialysis patients.Kidney Int. 2004; 66: 2010-2016
Article info
Publication history
Accepted:
June 5,
2007
Footnotes
Supported by the Fundação De Amparo À Pesquisa Do Estado de São Paulo (FAPESP).
Identification
Copyright
© 2007 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
