title: Reduced Stroke Risk After Parathyroidectomy in End-Stage Renal Disease: A 13-Year Population-Based Cohort Study.
abstract: Research information on the risk of stroke in patients with dialysis-dependent end-stage renal disease (ESRD) who have undergone parathyroidectomy (PTX) is scant. We used a nationwide health insurance claims database to select all patients with dialysis-dependent ESRD age 18 years and older for the study population. Of the patients with ESRD, we selected 1083 patients who had undergone PTX between 1998 and 2006 as the PTX group and frequency-matched 1083 patients with ESRD by sex, age, years since the disease diagnosis, and the year of undergoing PTX as the non-PTX group. We used a multivariate Cox proportional hazards regression analysis to measure the risk of stroke for the PTX group compared with the non-PTX group after adjusting for sex, age, premium-based income, urbanization, and comorbidity. The mean follow-up periods were 6.08 and 5.38 years for the PTX and non-PTX groups, respectively. After adjusting for previously mentioned variables, significant risk reductions of stroke (adjusted hazard ratio = 0.57, 95% confidence interval = 0.41-0.79), particularly those of hemorrhagic stroke (adjusted hazard ratio = 0.34, 95% confidence interval = 0.20-0.57), with PTX were observed. Chronologically, the risk of stroke in the PTX group decreased in the second year after PTX and persisted for >3 years. PTX reduces the risk of stroke, particularly that of hemorrhagic stroke, in patients with dialysis-dependent ESRD. Other factors for risk reduction include sex (females), an age <65 years, and the presence of comorbidity.
authors.affiliation: From the Department of Public Health and Department of Health Services Administration, China Medical University, Taichung City (Y-HH, S-CS, W-CT); Department of Internal Medicine, Division of Nephrology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City (Y-HH); Department of Nursing, Min-Hwei Junior College of Health Care Management, Tainan City (Y-HH); Management Office for Health Data, China Medical University Hospital, Taichung City (H-JC); College of Medicine, China Medical University, Taichung City (H-JC); Department of Medical Affairs, Buddhist Dalin Tzu Chi Hospital, Chiayi (S-CS); Department of Health Services Administration, Chia Nan University of Pharmacy & Science, Tainan (S-CS); Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County (C-CH); Department of Health Services Administration, China Medical University and Hospital, Taichung City (C-CH); Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung City (C-HK); and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung City (C-HK), Taiwan.
authors.forename: Yueh-Han
authors.initials: YH
authors.lastname: Hsu
authors.forename: Hsuan-Ju
authors.initials: HJ
authors.lastname: Chen
authors.forename: Szu-Ching
authors.initials: SC
authors.lastname: Shen
authors.forename: Wen-Chen
authors.initials: WC
authors.lastname: Tsai
authors.forename: Chih-Cheng
authors.initials: CC
authors.lastname: Hsu
authors.forename: Chia-Hung
authors.initials: CH
authors.lastname: Kao
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000150:complications* / Q000601:surgery*; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016105:Parathyroidectomy; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control*; D013997:Time Factors; D055815:Young Adult