title: Aluminum overload hampers symptom improvement following parathyroidectomy for secondary hyperparathyroidism.
abstract: BACKGROUND
  Aluminum overload and accumulation in tissues may lead to skeletal, hematological, and neurological toxicity. The aim of this study was to assess the effects of serum aluminum levels on presentations, postoperative recovery, and symptom improvement in patients undergoing parathyroidectomy for secondary hyperparathyroidism.
  
  
  METHODS
  From 2008 to 2013, all patients with end-stage renal disease undergoing initial parathyroidectomy were included in the study. Serum aluminum level was measured preoperatively and/or within 1 week after surgery. Preoperative and postoperative biochemical profile and symptoms were compared between the low and high aluminum groups.
  
  
  RESULTS
  A total of 176 patients were included in the study. Of these, 38 (22 %) patients had serum aluminum levels higher than 20 μg/L. A higher percentage of patients in the high aluminum group were on peritoneal dialysis than in the low aluminum group (24 vs. 4 %, p = 0.001). Both groups had similar bone mineral density and changes in biochemical profiles. The preoperative parathyroidectomy assessment of symptoms (PAS) score was not associated with serum aluminum levels (p = 0.349), whereas the postoperative PAS score showed positive association (p = 0.005). There was a negative association between serum aluminum levels and the improvement of total PAS scores (p = 0.001). The high aluminum group had more residual symptoms in three aspects: bone pain (p = 0.038), difficulty getting out of a chair or car (p = 0.045), and pruritus (p = 0.041).
  
  
  CONCLUSIONS
  A high serum aluminum level was associated with reduced symptom improvement in patients undergoing parathyroidectomy for secondary hyperparathyroidism.
authors.affiliation: Department of Surgery, Mackay Memorial Hospital, Mackay Medical College, 92, Sec. 2, Zhongshan N. Rd, Taipei, 10449, Taiwan.
authors.forename: Shih-Ping
authors.initials: SP
authors.lastname: Cheng
authors.forename: Jie-Jen
authors.initials: JJ
authors.lastname: Lee
authors.forename: Tsang-Pai
authors.initials: TP
authors.lastname: Liu
authors.forename: Han-Hsiang
authors.initials: HH
authors.lastname: Chen
authors.forename: Chih-Jen
authors.initials: CJ
authors.lastname: Wu
authors.forename: Chien-Liang
authors.initials: CL
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D000535:Aluminum / Q000097:blood*; D015519:Bone Density; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000097:blood* / Q000209:etiology / Q000601:surgery*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000097:blood / Q000209:etiology; D016105:Parathyroidectomy; D010530:Peritoneal Dialysis; D011184:Postoperative Period; D011537:Pruritus / Q000097:blood / Q000209:etiology; D012720:Severity of Illness Index
chemical_list: D000535:Aluminum