Survival after parathyroidectomy in patients with end-stage renal disease and severe hyperparathyroidism.
BACKGROUND
Patients with end-stage renal disease (ESRD) and secondary hyperparathyroidism (SHPT) are at high risk of mortality. Whether an increased risk of death persists after a parathyroidectomy (PTX) is not clearly established.


METHODS
The survival of 40 patients with ESRD and SHPT who underwent PTX was compared with that of 664 ESRD patients.


RESULTS
From first dialysis, a lower mortality rate was found in the group of patients who underwent PTX than in the nonoperated ESRD group (hazard ratio: 0.23; 95% CI: 0.14-0.37). The patients who underwent PTX were younger, had a longer time on dialysis, and had a higher prevalence of kidney transplantation. The mean number of comorbidities was lower (Charlson score 4.2 +/- 2.1 versus 6.4 +/- 2.9, p < 0.001). Then, we randomly selected two matched controls for each PTX case (80 controls, 40 PTX) who had at least an equivalent mean duration of dialysis between the first dialysis and PTX of the PTX group. In a univariate model, there was a trend for PTX being associated with prolonged survival. The mortality was higher both among those at an advanced age and those with a high Charlson score. Adjustments for these covariates made the effect of PTX no more significant.


CONCLUSIONS
The risk of death of patients with severe SHPT leading to PTX differed from that of nonoperated subjects. The apparent differences in survival may be related to the number and severity of associated comorbidities. ESRD patients who undergo PTX may represent a subset of healthier subjects.
Trombetti
Andrea
A
Service of Bone Diseases (WHO Collaborating Center for Osteoporosis Prevention), Department of Rehabilitation and Geriatrics, University Hospital of Geneva, 1211, Geneva 14, Switzerland. Andrea.Trombetti@hcuge.ch
Stoermann
Catherine
C
Robert
John H
JH
Herrmann
François R
FR
Pennisi
Pietra
P
Martin
Pierre-Yves
PY
Rizzoli
René
R
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000209:etiology* / Q000601:surgery*; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D016105:Parathyroidectomy / Q000379:methods*; D006435:Renal Dialysis; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome