Parathyroidectomy reduces cardiovascular events and mortality in renal hyperparathyroidism.
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).


CONCLUSIONS
PTX confers protection against future major cardiovascular events and death in select CRF patients with severe refractory SHPT.
Costa-Hong
Valeria
V
Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
Jorgetti
Vanda
V
Gowdak
Luis Henrique W
LH
Moyses
Rosa Maria A
RM
Krieger
Eduardo M
EM
De Lima
Jose Jayme G
JJ
D000328:Adult; D002318:Cardiovascular Diseases / Q000401:mortality*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000401:mortality* / Q000601:surgery*; D015994:Incidence; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D016105:Parathyroidectomy / Q000401:mortality*; D012307:Risk Factors; D012720:Severity of Illness Index