Parathyroidectomized patients have impaired capacity of peripheral vascular constriction during hemodialysis.
Parathyroidectomy (PTx) seems to improve cardiovascular outcomes and reduce blood pressure levels. However, the effect of PTx on hemodynamic changes during hemodialysis (HD) is still overlooked. This was a prospective cohort design. Patients with end-stage renal disease on maintenance HD were included. Diabetes and nonsinusal rhythm were exclusion criteria. History of PTx was recorded. Finometer monitor was used to access parameters immediately pre- and post-HD sessions. Cardiac index (CI) variation (ΔCI) and peripheral arterial resistance variation (ΔPAR) were the variables of interest. Biochemical and echocardiographic data were also obtained. PTx patients (n = 11) were matched to non-PTx patients (n = 20). ΔPAR was lower in PTx group in comparison with non-PTx group (P = 0.039), which was independent of parathyroid hormone (PTH) levels. Multiple regression analysis showed that PTx, ΔCI, and dialysate calcium remained independently associated with PAR variation and even adjusted for ultrafiltration rate (adjusted r(2)  = 0.64). In conclusion, parathyroidectomized patients have impaired capacity of vasoconstriction in response to ultrafiltration, an effect independent of serum PTH levels. Further studies are needed to elucidate mechanisms explaining the interaction between PTx and systemic vascular tonus.
Nephrology Division, Universidade de São Paulo, São Paulo, Brazil.
Bruno C
http://orcid.org/0000-0001-9568-0974
BC
Silva
Nephrology Division, Universidade de São Paulo, São Paulo, Brazil.|UNINOVE, Universidade Nove de Julho, São Paulo, Brazil.
Rosa M A
RM
Moysés
Nephrology Division, Universidade de São Paulo, São Paulo, Brazil.
Vitor B
VB
Silva
Nephrology Division, Universidade de São Paulo, São Paulo, Brazil.
Geraldo R R
GR
Freitas
Nephrology Division, Universidade de São Paulo, São Paulo, Brazil.
Rosilene M
RM
Elias
D000328:Adult; D015331:Cohort Studies; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy / Q000379:methods*; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects* / Q000401:mortality
D010281:Parathyroid Hormone
Hemodynamic; hemodialysis; parathyroid hormone; parathyroidectomy; peripheral arterial resistance