title: Parathyroidectomy Associates with Reduced Mortality in Taiwanese Dialysis Patients with Hyperparathyroidism: Evidence for the Controversy of Current Guidelines.
abstract: Parathyroidectomy is recommended by the clinical guidelines for dialysis patients with unremitting secondary hyperparathyroidism (SHPT). However, the survival advantage of parathyroidectomy is debated because of the selection bias in previous studies. To minimize potential bias in the present nationwide cohort study, we enrolled only dialysis patients who had undergone radionuclide parathyroid scanning to ensure all patients had severe SHPT. The parathyroidectomized patients were matched with the controls based on propensity score for parathyroidectomy. Mortality hazard was estimated using multivariate Cox proportional hazard models adjusting for comorbidities before scanning (model 1) or over the whole study period (model 2). Our results showed that among the 2786 enrolled patients, 1707 underwent parathyroidectomy, and the other 1079 were controls. The crude mortality rates were lower in the parathyroidectomized patients than in the controls. In adjusted analyses for the population matched on propensity score, parathyroidectomy was associated with a significant 20% to 25% lower risk for all-cause mortality (model 1: hazard ratio 0.76, 95% confidence interval 0.61 to 0.94; model 2: hazard ratio 0.80, 95% confidence internal 0.64 to 0.98). We concluded that parathyroidectomy was associated with a reduced long-term mortality risk in dialysis patients with severe SHPT.
authors.affiliation: Graduate Institute of Clinical Medicine, National Cheng Kung University, Tainan.|Division of Nephrology, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung.
authors.forename: Li-Chun
authors.initials: LC
authors.lastname: Ho
authors.affiliation: Division of Nephrology, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung.
authors.forename: Shih-Yuan
authors.initials: SY
authors.lastname: Hung
authors.affiliation: Division of Nephrology, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung.
authors.forename: Hsi-Hao
authors.initials: HH
authors.lastname: Wang
authors.affiliation: Department of Internal Medicine, National Cheng Kung University Medical College and Hospital, Tainan.|Graduate Institute of Public Health, National Cheng Kung University, Tainan.
authors.forename: Te-Hui
authors.initials: TH
authors.lastname: Kuo
authors.affiliation: Graduate Institute of Clinical Medicine, National Cheng Kung University, Tainan.|Department of Internal Medicine, National Cheng Kung University Medical College and Hospital, Tainan.
authors.forename: Yu-Tzu
authors.initials: YT
authors.lastname: Chang
authors.affiliation: Department of Internal Medicine, National Cheng Kung University Medical College and Hospital, Tainan.
authors.forename: Chin-Chung
authors.initials: CC
authors.lastname: Tseng
authors.affiliation: Department of Internal Medicine, National Cheng Kung University Medical College and Hospital, Tainan.
authors.forename: Jia-Ling
authors.initials: JL
authors.lastname: Wu
authors.affiliation: Department of Public Health, National Cheng Kung University College of Medicine, Tainan.|Department of Public Health, College of Public Health, China Medical University, Taichung.
authors.forename: Chung-Yi
authors.initials: CY
authors.lastname: Li
authors.affiliation: Department of Internal Medicine, National Cheng Kung University Medical College and Hospital, Tainan.|Department of Public Health, National Cheng Kung University College of Medicine, Tainan.|Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
authors.forename: Jung-Der
authors.initials: JD
authors.lastname: Wang
authors.affiliation: Graduate Institute of Clinical Medicine, National Cheng Kung University, Tainan.
authors.forename: Yau-Sheng
authors.initials: YS
authors.lastname: Tsai
authors.affiliation: Department of Internal Medicine, National Cheng Kung University Medical College and Hospital, Tainan.
authors.forename: Junne-Ming
authors.initials: JM
authors.lastname: Sung
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009026:Mortality; D016105:Parathyroidectomy; D017410:Practice Guidelines as Topic; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000009:adverse effects; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome