title: Resurgence of parathyroidectomy: evidence and outcomes.
abstract: Parathyroidectomy (PTx) is the definitive therapy for refractory secondary hyperparathyroidism (SHPT). The drastic effects of PTx on biochemical parameters of SHPT increases the possibility that this intervention will lead to a reduction in the adverse outcomes related to uncontrolled SHPT.
  
  
  
  The effect of PTx on mortality and cardiovascular outcomes among dialysis patients with severe SHPT have been evaluated in many observational studies from different regions of the world, including Asia, Europe, North America, and South America. In all but one small study, there was a significant association of PTx with lower all-cause mortality. In addition, in all studies, there was a trend in favor of PTx for cardiovascular morbidity and mortality. The effect of PTx on fractures has been evaluated in only one epidemiological study from the United States, which demonstrated a significant association of PTx and lower hip and combined fractures.
  
  
  
  Although randomized evidence is lacking, these highly consistent results may suggest a strong beneficial effect of PTx on long-term clinical outcomes and eliminate the potential concern of low parathyroid hormone after PTx.
authors.affiliation: aDivision of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine bThe Institute of Medical Sciences, Tokai University cDepartment of Transplant Surgery, Tokai University School of Medicine, Isehara, Japan.
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Komaba
authors.forename: Michio
authors.initials: M
authors.lastname: Nakamura
authors.forename: Masafumi
authors.initials: M
authors.lastname: Fukagawa
mesh_terms: D001208:Asia; D005060:Europe; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000209:etiology / Q000601:surgery*; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000032:analysis / Q000172:deficiency; D016105:Parathyroidectomy / Q000639:trends*; D006435:Renal Dialysis / Q000009:adverse effects*; D018570:Risk Assessment; D061205:Vascular Calcification / Q000209:etiology / Q000473:pathology
chemical_list: D010281:Parathyroid Hormone