The Risk of Peripheral Arterial Disease after Parathyroidectomy in Patients with End-Stage Renal Disease.
OBJECTIVE
The changes of the risk of peripheral arterial disease (PAD) in patients with end-stage renal disease after parathyroidectomy are scant.


METHODS
We used a nationwide health insurance claims database to select all dialysis-dependent patients with end-stage renal disease aged 18 years and older for the study population in 2000 to 2006. Of the patients with end-stage renal disease, we selected 947 patients who had undergone parathyroidectomy as the parathyroidectomy group and frequency matched 3746 patients with end-stage renal disease by sex, age, years since the disease diagnosis, and the year of index date as the non-parathyroidectomy group. We used a multivariate Cox proportional hazards regression analysis with the use of a robust sandwich covariance matrix estimate, accounting for the intra-cluster dependence of hospitals or clinics, to measure the risk of peripheral arterial disease for the parathyroidectomy group compared with the non-parathyroidectomy group after adjusting for sex, age, premium-based income, urbanization, and comorbidity.


RESULTS
The mean post-op follow-up periods were 5.08 and 4.52 years for the parathyroidectomy and non-parathyroidectomy groups, respectively; the incidence density rate of PAD in the PTX group was 12.26 per 1000 person-years, significantly lower than the data in the non-PTX group (24.09 per 1000 person-years, adjusted HR = 0.66, 95% CI = 0.46-0.94).


CONCLUSIONS
Parathyroidectomy is associated with reduced risk of peripheral arterial disease in patients with end-stage renal disease complicated with severe secondary hyperparathyroidism.
Department of Health Services Administration, China Medical University, Taichung, Taiwan.|Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan.|Department of Nursing, Min-Hwei Junior College of Health Care Management, Tainan, Taiwan.
Yueh-Han
YH
Hsu
Division of Endocrinology and Metabolism, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yiy, Taiwan.|Department of Sports Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
Hui-Yi
HY
Yu
Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.|College of Medicine, China Medical University, Taichung, Taiwan.
Hsuan-Ju
HJ
Chen
Graduate Institute of Biostatistics, College of Public Health, China Medical University, Taichung, Taiwan.|Department of Healthcare Administration, College of Health Science, Asia University, Taichung, Taiwan.
Tsai-Chung
TC
Li
Department of Health Services Administration, China Medical University, Taichung, Taiwan.|Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli, Taiwan.
Chih-Cheng
CC
Hsu
Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.|Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.
Chia-Hung
CH
Kao
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005500:Follow-Up Studies; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000150:complications / Q000453:epidemiology / Q000601:surgery; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000453:epidemiology / Q000628:therapy; D008875:Middle Aged; D016105:Parathyroidectomy / Q000009:adverse effects* / Q000706:statistics & numerical data; D058729:Peripheral Arterial Disease / Q000453:epidemiology / Q000209:etiology*; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult