Survival following parathyroidectomy among United States dialysis patients.
BACKGROUND
Secondary hyperparathyroidism (SHPTH) is highly prevalent among persons with end-stage renal disease (ESRD). SHPTH has been linked to uremic bone disease, vascular calcification, and a higher risk of death. Parathyroidectomy (PTX) can dramatically reduce parathyroid hormone (PTH) and phosphate levels; however, the relationship between PTX and survival is not known.


METHODS
We conducted an observational matched cohort study utilizing data from the United States Renal Database System (USRDS) in which 4558 patients undergoing a first PTX while on hemodialysis or peritoneal dialysis were individually matched by age, race, gender, cause of ESRD, dialysis duration, prior transplantation status, and dialysis modality to 4558 control patients who did not undergo PTX. Patients were followed from the date of PTX until they died or were lost to follow-up.


RESULTS
The 30-day postoperative mortality rate following PTX was 3.1%. Long-term relative risks of death among patients undergoing PTX were estimated to be 10% to 15% lower than those of matched control patients not undergoing surgery. Survival curves between the 2 groups crossed 587 days following PTX. Median survival was 53.4 months (95% CI: 51.2-56.4) in the PTX group, and 46.8 months (95% CI: 44.7-48.9) in the control group.


CONCLUSIONS
PTX was associated with higher short-term, and lower long-term, mortality rates among U.S. patients receiving chronic dialysis. Measures to attenuate SHPTH may play an important role in reducing mortality among patients with end-stage renal disease.
Kestenbaum
Bryan
B
Division of Nephrology, University of Washington, Veterans' Affairs Puget Sound Health Care System, Seattle, Washington 98108, USA. brk@u.washington.edu
Andress
Dennis L
DL
Schwartz
Stephen M
SM
Gillen
Daniel L
DL
Seliger
Stephen L
SL
Jadav
Paresh R
PR
Sherrard
Donald J
DJ
Stehman-Breen
Catherine
C
D000328:Adult; D016022:Case-Control Studies; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000209:etiology* / Q000601:surgery*; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016105:Parathyroidectomy / Q000401:mortality; D006435:Renal Dialysis; D012306:Risk; D016019:Survival Analysis; D013997:Time Factors; D014481:United States