Parathyroidectomy improves survival in patients with severe hyperparathyroidism: a comparative study.
OBJECTIVE
Secondary hyperparathyroidism (SHPT) in CKD is associated with an increased risk for mortality, but definitive data showing that parathormone control decreases mortality is still lacking. This study aimed to compare the mortality of patients with severe SHPT submitted to parathyroidectomy(PTX) with those who did not have access to surgery.


METHODS
This is a retrospective study in a cohort of 251 CKD patients with severe SHPT who were referred to a CKD-MBD Center for PTX from 2005 until 2012.


RESULTS
Most of our patients had indication of PTX, but only 49% of them had access to this surgical procedure. After a mean follow-up of 23 months, 72 patients had died. Non-survivors were older; more often had diabetes, lower serum 25 vitamin D and mostly had not been submitted to surgery. The relative risk of death was lower in the PTX patients (0.428; 95% CI, 0.28 to 0.67; p<0.0001). After adjustments, mortality risk was dependent on age (1.04; 95% CI, 1.01 to 1.07; p = 0.002), 25 vitamin D (0.43; 95% CI, 0.24 to 0.81; p = 0.006) and no access to PTX (4.13; 95% CI, 2.16 to 7.88; p<0.0001). Results remained the same in a second model using the PTX date as the study start date for the PTX group.


CONCLUSIONS
Our data confirms the benefit of PTX on mortality in patients with severe SHPT. The high mortality encountered in our population is significant and urges the need to better treat these patients.
Nephrology Division, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Patricia Taschner
PT
Goldenstein
Rosilene Motta
RM
Elias
Lilian
L
Pires de Freitas do Carmo
Fernanda Oliveira
FO
Coelho
Luciene Pereira
LP
Magalhães
Gisele Lins
GL
Antunes
Melani Ribeiro
MR
Custódio
Fábio Luiz de Menezes
FL
Montenegro
Silvia Maria
SM
Titan
Vanda
V
Jorgetti
Rosa Maria Affonso
RM
Moysés
D000328:Adult; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016105:Parathyroidectomy; D051436:Renal Insufficiency, Chronic / Q000601:surgery; D012189:Retrospective Studies