Improvement of anemia after parathyroidectomy in Chinese patients with renal failure undergoing long-term dialysis.
OBJECTIVE
Most patients undergoing long-term dialysis are anemic because of underproduction of erythropoietin and its inhibition by high parathyroid hormone levels due to secondary hyperparathyroidism. Renal anemia can be improved by parathyroidectomy.


METHODS
Retrospective cohort study.


METHODS
Regional hospital.


METHODS
Twenty-three Chinese patients without a previous functioning renal transplant underwent parathyroidectomy for severe secondary hyperparathyroidism in a 3-year period.


METHODS
Total parathyroidectomy with or without parathyroid autograft at the forearm.


METHODS
The preoperative and 6-month postoperative hematological and biochemical variables were compared for any differences by means of a paired t test.


RESULTS
The mean +/- SD follow-up duration was 17.7 +/- 8.1 (range, 6-34) months. Three patients (13%) developed persistent or recurrent hyperparathyroidism and 2 patients (9%) were biochemically hypoparathyroid. The other 18 patients (78%) were euparathyroid. Surgical morbidity was minimal; only 1 patient had complications, consisting of a postoperative fever of unknown origin that resolved with conservative treatment. The mean +/- SD hemoglobin level (8.6 +/- 2.1 vs 9.4 +/- 2.1 g/dL) but not the mean platelet level was significantly (P = .04) increased 6 months postoperatively. Likewise, the following other mean +/- SD biochemical values improved after surgery: parathyroid hormone (2235 +/- 500 vs 151 +/- 312 pg/mL; P<.001), alkaline phosphatase (645 +/- 349 vs 123 +/- 82 U/L; P<.001), calcium (10.8 +/- 4.0 vs 9.3 +/- 1.0 mg/dL; P<.001), phosphate (1.93 +/- 0.73 vs 1.50 +/- 0.51 mmol/L; P = .02), and albumin (3.5 +/- 0.5 vs 3.8 +/- 0.6 g/dL; P = .006).


CONCLUSIONS
Parathyroidectomy is highly effective to control secondary hyperparathyroidism with an exceedingly low complication rate. The hemoglobin level was significantly elevated 6 months postoperatively. The long-term effect warrants future trials.
Chow
Tam-Lin
TL
Division of Head and Neck, Reconstructive and Breast Surgery, Department of Surgery, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong.
Chan
Tony Tung-Fei
TT
Ho
Yiu-Wing
YW
Lam
Siu-Ho
SH
D000328:Adult; D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood; D000740:Anemia / Q000628:therapy*; D002118:Calcium / Q000097:blood; D002681:China; D015331:Cohort Studies; D005260:Female; D005335:Fever of Unknown Origin / Q000209:etiology; D005500:Follow-Up Studies; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000601:surgery; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000637:transplantation; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy; D010710:Phosphates / Q000097:blood; D010976:Platelet Count; D011183:Postoperative Complications; D012008:Recurrence; D006435:Renal Dialysis; D012189:Retrospective Studies; D012709:Serum Albumin / Q000032:analysis
D006454:Hemoglobins; D010281:Parathyroid Hormone; D010710:Phosphates; D012709:Serum Albumin; D000469:Alkaline Phosphatase; D002118:Calcium