title: Survival after parathyroidectomy in chronic hemodialysis patients with severe secondary hyperparathyroidism.
abstract: BACKGROUND
  The life for end-stage renal disease patients has remarkably improved in the last years. Although mineral and bone disorders remain as unsolved complication, in severe secondary hyperparathyroidism (sHPT), the ultimate treatment is parathyroidectomy (PTX). It is an old treatment, but there are still insufficient data regarding survival after PTX. The study goals were to compare 2-year mortality and morbidity after PTX in surgically versus medically treated sHPT and to compare the efficacy and safety in subtotal versus total PTX in a cohort of patients receiving hemodialysis (HD).
  
  
  METHODS
  This prospective, longitudinal study was carried out on a cohort of chronic HD patients with severe sHPT (iPTH over 700 pg/ml). Among the overall HD population, 26 patients underwent PTX. This group was compared to a control group treated with specific drugs. Laboratory parameters, specific symptoms and mortality were registered after 24 months of follow-up for each group. The subgroups of subtotal and total PTX patients were also compared.
  
  
  RESULTS
  All average values of mineral markers were significantly reduced after PTX, as a proof that surgical treatment was effective. The reduction in mineral markers and the improvement in symptoms and mortality rates were similar after total and subtotal PTX. Bone pain was significantly lower in patients after PTX than in those drug treated (p = 0.0005), but not muscle weakness and itching. Survival at 2 years was better in patients surgically treated (PTX) despite significantly higher mean baseline values of iPTH, Ca and ALP compared to patients medically treated (p = 0.03).
  
  
  CONCLUSIONS
  We compared clinical and laboratory outcomes in HD patients with severe sHPT. Mortality, bone pain and mineral markers were improved by PTX. Total and subtotal PTX had similar clinical outcomes.
authors.affiliation: Department of Nephrology, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania. dnmoldovan@yahoo.com.|Emergency County Hospital, "Mihai Manasia" Nephrology and Dialysis Clinic, 3-5 Clinicilor Street, Cluj- Napoca, Romania. dnmoldovan@yahoo.com.
authors.forename: Diana
authors.initials: D
authors.lastname: Moldovan
authors.affiliation: Nefromed Dialysis Center, Cluj-Napoca, Romania.
authors.forename: Simona
authors.initials: S
authors.lastname: Racasan
authors.affiliation: Department of Nephrology, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania.
authors.forename: Ina Maria
authors.initials: IM
authors.lastname: Kacso
authors.affiliation: Department of Nephrology, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania.
authors.forename: Crina
authors.initials: C
authors.lastname: Rusu
authors.affiliation: Department of Nephrology, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania.
authors.forename: Alina
authors.initials: A
authors.lastname: Potra
authors.affiliation: Department of Statistics, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania.
authors.forename: Cosmina
authors.initials: C
authors.lastname: Bondor
authors.affiliation: Nefromed Dialysis Center, Cluj-Napoca, Romania.
authors.forename: Ioan Mihai
authors.initials: IM
authors.lastname: Patiu
authors.affiliation: Department of Nephrology, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania.
authors.forename: Mirela
authors.initials: M
authors.lastname: Gherman-Căprioară
mesh_terms: D000328:Adult; D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D002118:Calcium / Q000097:blood; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D018908:Muscle Weakness / Q000209:etiology; D010146:Pain / Q000209:etiology; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy / Q000009:adverse effects / Q000379:methods*; D010758:Phosphorus / Q000097:blood; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011537:Pruritus / Q000209:etiology; D006435:Renal Dialysis; D012720:Severity of Illness Index; D015996:Survival Rate
chemical_list: D006454:Hemoglobins; D010281:Parathyroid Hormone; D010758:Phosphorus; D002097:C-Reactive Protein; D000469:Alkaline Phosphatase; D002118:Calcium
keywords: Hemodialysis patients; Parathyroidectomy; Secondary hyperparathyroidism; Survival