title: The shift from high to low turnover bone disease after parathyroidectomy is associated with the progression of vascular calcification in hemodialysis patients: A 12-month follow-up study.
abstract: Parathyroidectomy (PTX) may cause low levels of PTH, leading to an excessive reduction of bone turnover, which is associated with poor outcomes in dialysis patients, including vascular calcification (VC). We aimed to prospectively investigate the impact of PTX on bone remodeling and its potential consequence on the progression of VC in hemodialysis patients. In this prospective study, 19 hemodialysis patients with severe secondary hyperparathyroidism (sHPT) were evaluated. All patients underwent laboratorial tests and coronary tomography at baseline and, 6 and 12 months after PTX; bone biopsy was performed at baseline and 12-month. At baseline, all patients had increased PTH levels up to 2500 pg/mL and high turnover bone disease in their bone biopsies. Fourteen (74%) patients had VC. During the follow-up, there was a significant decrease of PTH at 6 and 12-month. At 12-month, 90% of the patients evolved to low turnover bone disease. During the period of the hungry bone syndrome (first 6 months), no change of coronary calcium score was observed. However, calcium score increased significantly thereafter (12th month). There was an association between VC progression and the severity of low turnover bone disease. In conclusion, the shift from high to low turnover bone disease after PTX occurs in parallel to VC progression, contributing to the understanding of the complex pathophysiology involving mineral metabolism and cardiovascular disease in hemodialysis patients.
authors.affiliation: Nephrology Division, Federal University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Fabiana Rodrigues
authors.initials: FR
authors.lastname: Hernandes
authors.affiliation: Nephrology Division, Federal University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Maria Eugênia Fernandes
authors.initials: ME
authors.lastname: Canziani
authors.affiliation: Nephrology Division, Federal University of Parana, Parana, Brazil.
authors.forename: Fellype Carvalho
authors.initials: FC
authors.lastname: Barreto
authors.affiliation: Head and Neck Surgery Division, Federal University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Rodrigo Oliveira
authors.initials: RO
authors.lastname: Santos
authors.affiliation: Cardiology Division, University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Valéria de Melo
authors.initials: VM
authors.lastname: Moreira
authors.affiliation: Cardiology Division, University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Carlos Eduardo
authors.initials: CE
authors.lastname: Rochitte
authors.affiliation: Nephrology Division, Federal University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Aluizio Barbosa
authors.initials: AB
authors.lastname: Carvalho
mesh_terms: D000328:Adult; D001706:Biopsy; D016723:Bone Remodeling; D001842:Bone and Bones / Q000473:pathology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016105:Parathyroidectomy; D011446:Prospective Studies; D006435:Renal Dialysis; D061205:Vascular Calcification / Q000473:pathology*