title: Improved long-term survival of dialysis patients after near-total parathyroidectomy.
abstract: BACKGROUND
  Severe secondary hyperparathyroidism, which is associated with life-threatening complications, can develop in dialysis-dependent end-stage renal disease patients. The aim of this study was to compare short- and long-term mortality in dialysis patients who underwent near-total parathyroidectomy (NTPTX) and matched nonoperated controls.
  
  
  METHODS
  We identified 150 dialysis patients who underwent NTPTX (1993-2009) at our institution and compared them with 1,044 nonoperated control patients identified in the US Renal Data System registry, matched for age, sex, race, diabetes as cause of kidney failure, years on dialysis, and dialysis modality. Survival outcomes were estimated using multivariable Cox proportional hazards models with stratification on the matching sets, adjusted for cardiovascular comorbidities, smoking, inability to ambulate/transfer, and payor status.
  
  
  RESULTS
  During a follow-up of a mean of 3.6 years (range 0.1 month to 16.4 years), NTPTX patients had a significant reduction in the long-term risk of all-cause death (hazard ratio = 0.68; 95% CI, 0.52-0.89; p = 0.006) compared with controls. Thirty-day mortality rates for NTPTX patients and controls were 246 vs 105 per 1,000 person-years (p = 0.21). In adjusted analyses, NTPTX patients had a 37% reduced risk of all-cause death and a 33% reduced risk of cardiovascular death compared with controls. A durable reduction in mean parathyroid hormone was observed after NTPTX; from 1,776 ± 1,416.6 pg/mL to 301 ± 285.7 pg/mL (p < 0.0001).
  
  
  CONCLUSIONS
  In our center, NTPTX in dialysis patients was associated with a significant reduction in long-term risk of death compared with matched control patients, without a significantly increased short-term risk.
authors.affiliation: Department of Surgery, Emory University, Atlanta, GA 30322, USA. jsharm3@emory.edu
authors.forename: Jyotirmay
authors.initials: J
authors.lastname: Sharma
authors.forename: Paolo
authors.initials: P
authors.lastname: Raggi
authors.forename: Nancy
authors.initials: N
authors.lastname: Kutner
authors.forename: James
authors.initials: J
authors.lastname: Bailey
authors.forename: Rebecca
authors.initials: R
authors.lastname: Zhang
authors.forename: Yijian
authors.initials: Y
authors.lastname: Huang
authors.forename: Charles A
authors.initials: CA
authors.lastname: Herzog
authors.forename: Collin
authors.initials: C
authors.lastname: Weber
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000097:blood / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy / Q000379:methods*; D016016:Proportional Hazards Models; D006435:Renal Dialysis; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D010281:Parathyroid Hormone