title: Parathyroidectomy Is Associated with Reduced Mortality in Hemodialysis Patients with Secondary Hyperparathyroidism.
abstract: Secondary hyperparathyroidism increases morbidity and mortality in hemodialysis patients. The Kidney Disease Outcomes Quality Initiative Guidelines recommend parathyroidectomy for patients with chronic kidney disease and parathyroid hormone concentrations exceeding 800 pg/mL; however, this concentration represents an arbitrary cut-off value. The present study was conducted to identify factors influencing mortality in hemodialysis patients with parathyroid hormone concentrations exceeding 800 pg/mL and to evaluate the effects of parathyroidectomy on outcome for these patients. Two hundred twenty-one hemodialysis patients with parathyroid hormone concentrations > 800 pg/mL from July 2004 to June 2010 were identified. 21.1% of patients (n = 60) received parathyroidectomy and 14.9% of patients (n = 33) died during a mean follow-up of 36 months. Patients with parathyroidectomy were found to have lower all-cause mortality (adjusted hazard ratio [aHR]: 0.34). Other independent predictors included age ≥ 65 years (aHR: 2.11) and diabetes mellitus (aHR: 3.80). For cardiovascular mortality, parathyroidectomy was associated with lower mortality (HR = 0.31) but with a marginal statistical significance (p = 0.061). In multivariate analysis, diabetes was the only significant predictor (aHR: 3.14). It is concluded that, for hemodialysis patients with parathyroid hormone concentrations greater than 800 pg/mL, parathyroidectomy is associated with reduced all-cause mortality.
authors.affiliation: Department of Internal Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, 539 Jhongsiao Road, Chiayi 600, Taiwan.
authors.forename: Tsung-Liang
authors.identifier: 0000-0002-4131-7966
authors.initials: TL
authors.lastname: Ma
authors.affiliation: Department of Internal Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, 539 Jhongsiao Road, Chiayi 600, Taiwan ; Department of Applied Life Science and Health, Chia Nan University of Pharmacy and Science, No. 60, Section 1, Erren Road, Rende District, Tainan 71710, Taiwan.
authors.forename: Peir-Haur
authors.initials: PH
authors.lastname: Hung
authors.affiliation: Department of Internal Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, 539 Jhongsiao Road, Chiayi 600, Taiwan.
authors.forename: Ing-Ching
authors.initials: IC
authors.lastname: Jong
authors.affiliation: Department of Internal Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, 539 Jhongsiao Road, Chiayi 600, Taiwan.
authors.forename: Chih-Yen
authors.initials: CY
authors.lastname: Hiao
authors.affiliation: Department of Internal Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, 539 Jhongsiao Road, Chiayi 600, Taiwan.
authors.forename: Yueh-Han
authors.initials: YH
authors.lastname: Hsu
authors.affiliation: Department of Internal Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, 539 Jhongsiao Road, Chiayi 600, Taiwan.
authors.forename: Pei-Chun
authors.initials: PC
authors.lastname: Chiang
authors.affiliation: Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, 1 University Road, Tainan 701, Taiwan ; Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, 138 Sheng Li Road, Tainan 704, Taiwan.
authors.forename: How-Ran
authors.initials: HR
authors.lastname: Guo
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, 7 Chung Shan South Road, Zhongzheng District, Taipei City 10002, Taiwan.
authors.forename: Kuan-Yu
authors.initials: KY
authors.lastname: Hung
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D007676:Kidney Failure, Chronic / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy; D006435:Renal Dialysis / Q000401:mortality; D016896:Treatment Outcome
chemical_list: D010281:Parathyroid Hormone