Improved Long-Term Survival of Dialysis Patients after Near-Total Parathyroidectomy

• Type of Material: Article
• Authors: Jyotirmay Sharma, Emory University; Paolo Raggi, Emory University; Nancy Kutner, Emory University; James Bailey, Emory University; Rebecca Zhang, Emory University; Yijian Huang, Emory University; Charles A Herzog, US Renal Data System Rehabilitation; Collin Weber, Emory University
• Language: English
• Date: 2012-04-01
• Publisher: Elsevier: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2012 by the American College of Surgeons.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jamcollsurg.2011.12.046
• Title of Journal or Parent Work: Journal of The American College of Surgeons
• ISSN: 1072-7515
• Volume: 214
• Issue: 4
• Start Page: 400
• End Page: 407
• Grant/Funding Information: Supported by The Emory University Parathyroid Surgery Research Fund and National Institutes of Health contract HHSN267200715004C, ADB No. N01-DK-7-5004.
• Keywords: Science & Technology; PTH; Life Sciences & Biomedicine; SERUM-CALCIUM; DISEASE; HYPERPARATHYROIDISM; HORMONE; Surgery; PHOSPHATE; CALCIFICATION; SECONDARY; HEMODIALYSIS-PATIENTS; MORTALITY RISK
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

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.