title: Total parathyroidectomy improves survival of hemodialysis patients with secondary hyperparathyroidism.
abstract: OBJECTIVE
  To compare the prognosis of chronic hemodialysis patients with or without parathyroidectomy.
  
  
  METHODS
  Among 158 chronic hemodialysis patients who underwent total parathyroidectomy between July 1998 and April 2009, 88 patients were matched with 88 controls for sex, age, underlying disease and prior dialysis history. Then a retrospective evaluation of their prognosis was performed over a median observation period of 4.41 years.
  
  
  RESULTS
  The overall survival rate was 90.4% in the parathyroidectomy group and 67.4% in the control group. The cardiovascular death-free survival rate was 94.6% in the parathyroidectomy group and 76.3% in the control group. During observation, intact parathyroid hormone was measured every 6 months, and its average serum level was 37 ± 92 ng/L in the total parathyroidectomy group versus 274 ± 233 ng/L in the control group (p=0.0001). The total parathyroidectomy group had a significantly lower corrected calcium level and higher serum albumin level. Multivariate analysis revealed that parathyroidectomy, atrial fibrillation and serum albumin were significant factors for both total and cardiovascular mortality.
  
  
  CONCLUSIONS
  Total parathyroidectomy was associated with better survival, probably due to decreased cardiovascular mortality.
authors.affiliation: Department of Urology, Tojinkai Hospital, Kyoto, Japan. iwamoto@tojinkai.jp
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Iwamoto
authors.forename: Nodoka
authors.initials: N
authors.lastname: Sato
authors.forename: Masaya
authors.initials: M
authors.lastname: Nishida
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Hashimoto
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kobayashi
authors.forename: Satoru
authors.initials: S
authors.lastname: Yamasaki
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Ono
authors.forename: Masato
authors.initials: M
authors.lastname: Nishimura
authors.forename: Toshiko
authors.initials: T
authors.lastname: Tokoro
authors.forename: Chikako
authors.initials: C
authors.lastname: Sakoda
authors.forename: Mayuko
authors.initials: M
authors.lastname: Murakawa
authors.forename: Koji
authors.initials: K
authors.lastname: Okino
authors.forename: Yuu
authors.initials: Y
authors.lastname: Okamoto
authors.forename: Ryo
authors.initials: R
authors.lastname: Imai
authors.forename: Naoto
authors.initials: N
authors.lastname: Adachi
authors.forename: Kanji
authors.initials: K
authors.lastname: Ninomiya
authors.forename: Hisao
authors.initials: H
authors.lastname: Mabuchi
authors.forename: Masaki
authors.initials: M
authors.lastname: Koyama
authors.forename: Tsuneyuki
authors.initials: T
authors.lastname: Nakanouchi
authors.forename: Kunitoshi
authors.initials: K
authors.lastname: Iseki
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002118:Calcium / Q000097:blood; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000097:blood / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy / Q000009:adverse effects / Q000401:mortality; D006435:Renal Dialysis / Q000009:adverse effects* / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; C470125:PTH protein, human; D010281:Parathyroid Hormone; D012709:Serum Albumin; D002118:Calcium