title: Low parathyroid hormone levels after parathyroidectomy reduce cardiovascular mortality in chronic hemodialysis patients.
abstract: BACKGROUND
  The aim of the study is to elucidate whether parathyroid hormone (PTH) levels after parathyroidectomy affect the prognosis of patients with secondary hyperparathyroidism.
  
  
  METHODS
  Two hundred and ninety-five patients, who underwent PTx without autotransplantation from July 1998 to December 2011, were divided into the low (n = 148) and high (n = 147) PTH groups, using the median value of each mean value of intact PTH after surgery (16.6 pg/mL). After observation for 5.00 years, we evaluated demographic factors, influences of postoperative mineral metabolism, magnitude of uremia, and vitamin D receptor activators on their prognosis, with the multivariate Cox proportional hazard model.
  
  
  RESULTS
  While overall survival rates in the high and low PTH groups were 54.9 and 74.2 %, respectively (P = 0.1500), cardiovascular survival rates were 71.6 and 94.4 %, respectively (P = 0.0256). The hazard ratio for cardiovascular mortality in the high PTH group (≥16.6 pg/mL) was 3.132 (P = 0.0470), and those in groups with the median age more than 59 years and with cardiovascular disease were 2.654 (P = 0.0589) and 3.377 (P = 0.0317), respectively. The intact PTH level 6 days after surgery and the mean postoperative intact PTH value showed a strong correlation (Spearman ρ = 0.9007, P < 0.0001, y = 0.4725x + 30.395, R2= 0.51798).
  
  
  CONCLUSIONS
  The present study suggests that maintaining low PTH levels after parathyroidectomy reduces cardiovascular mortality and improves the prognosis. Total parathyroidectomy (more than 4 glands) without autotransplantation seems to be one of the treatment options for managing severe secondary hyperparathyroidism.
authors.affiliation: Urology Division, Tojinkai Hospital, 83-1, Iga, Momoyama-cho, Fushimi-ku, Kyoto, 612-8026, Japan. iwamoto@tojinkai.jp.
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Iwamoto
authors.affiliation: Urology Division, Tojinkai Hospital, 83-1, Iga, Momoyama-cho, Fushimi-ku, Kyoto, 612-8026, Japan.
authors.forename: Nodoka
authors.initials: N
authors.lastname: Sato
authors.affiliation: Urology Division, Tojinkai Hospital, 83-1, Iga, Momoyama-cho, Fushimi-ku, Kyoto, 612-8026, Japan.
authors.forename: Masaya
authors.initials: M
authors.lastname: Nishida
authors.affiliation: Urology Division, Tojinkai Hospital, 83-1, Iga, Momoyama-cho, Fushimi-ku, Kyoto, 612-8026, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Hashimoto
authors.affiliation: Urology Division, Tojinkai Hospital, 83-1, Iga, Momoyama-cho, Fushimi-ku, Kyoto, 612-8026, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kobayashi
authors.affiliation: Urology Division, Tojinkai Hospital, 83-1, Iga, Momoyama-cho, Fushimi-ku, Kyoto, 612-8026, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Yamazaki
authors.affiliation: Urology Division, Tojinkai Hospital, 83-1, Iga, Momoyama-cho, Fushimi-ku, Kyoto, 612-8026, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Okino
authors.affiliation: Urology Division, Tojinkai Hospital, 83-1, Iga, Momoyama-cho, Fushimi-ku, Kyoto, 612-8026, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Nishimura
authors.affiliation: Urology Division, Tojinkai Hospital, 83-1, Iga, Momoyama-cho, Fushimi-ku, Kyoto, 612-8026, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Takatani
authors.affiliation: Urology Division, Tojinkai Hospital, 83-1, Iga, Momoyama-cho, Fushimi-ku, Kyoto, 612-8026, Japan.
authors.forename: Yu
authors.initials: Y
authors.lastname: Okamoto
authors.affiliation: Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan.
authors.forename: Tsuneyuki
authors.initials: T
authors.lastname: Nakanouchi
authors.affiliation: Nishijin Hospital, Kyoto, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Koyama
authors.affiliation: Mabuchi Clinic, Kyoto, Japan.
authors.forename: Naoto
authors.initials: N
authors.lastname: Adachi
authors.affiliation: Mabuchi Clinic, Kyoto, Japan.
authors.forename: Kanji
authors.initials: K
authors.lastname: Ninomiya
authors.affiliation: Mabuchi Clinic, Kyoto, Japan.
authors.forename: Hisao
authors.initials: H
authors.lastname: Mabuchi
authors.affiliation: Dialysis Unit, University of the Ryukyus Hospital, Okinawa, Japan.
authors.forename: Kunitoshi
authors.initials: K
authors.lastname: Iseki
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D018572:Disease-Free Survival; D015536:Down-Regulation; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010281:Parathyroid Hormone / Q000097:blood*; D016105:Parathyroidectomy / Q000009:adverse effects / Q000401:mortality; D016016:Proportional Hazards Models; D065840:Protective Factors; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; C470125:PTH protein, human; D010281:Parathyroid Hormone
keywords: Cardiovascular mortality; PTH; Parathyroidectomy; Secondary hyperparathyroidism