Survival after parathyroidectomy in chronic hemodialysis patients with severe secondary hyperparathyroidism

Abstract

We compared clinical and laboratory outcomes in HD patients with severe sHPT. Mortality, bone pain and mineral markers were improved by PTX. Total and subtotal PTX had similar clinical outcomes.

Long–term mortality after parathyroidectomy among chronic kidney disease patients with secondary hyperparathyroidism: a systematic review and meta-analysis

“…Even multivariate adjustments could never correct for all the clinical reasons for declining the surgical procedure. Third, the difference of mortality among different types of PTx was not assessed, though they reportedly have similar clinical outcomes in a present study 31 and a MetaAnalysis, 52 which was different with another Meta-Analysis. 53 Fourth, none of the studies formally assessed adverse events, and follow-up was shortalthough this would bias in favor of finding a decrease in mortality over time.…”

“…Of them, 37 studies were retrieved for detailed evaluation, and finally 24 studies were excluded due to absence of information on the outcomes of interest (19 articles) or provision of data only in abstract form (5 articles). Finally, 13 studies [19][20][21][22][23][24][25][26][27][28][29][30][31] fulfilled the eligibility criteria ( Figure 1), with 10052 PTx-treated patients and 12001 medically-treated patients (totally 22053 patients). The 13 studies were all cohort studies with sample sizes from 20 to 4558 patients, and reported prevalence rates of diabetes from 0% to 44.3%.…”

“…Most studies adjusted a wide range of potential confounders to investigate the association between PTx and all-cause mortality, including age, sex, body mass index (BMI), diabetes, duration of dialysis, and dialysis modality. Twelve studies presented data with all-cause mortality [19][20][21][22][23][24][25][26][27][28][29]31 and six studies with cardiovascular mortality. 19,20,23,26,28,30 Table 1 lists the key characteristics of the 13 studies.…”

“…We examined the 11 trials [19][20][21][22][23][24][25][26]28,29,31 that investigated the effect of PTx versus medical treatment on mortality against follow-up duration (<36 vs. 36 months). In the six trials with follow-up duration <36 months, the mortality rates are significantly different between PTxtreated and medically-treated patients (Figure 4).…”

Efficacy and its predictor in microwave ablation for severe secondary hyperparathyroidism in patients undergoing haemodialysis

“…The rates of achieving the recommended iPTH goals were comparable between the MWA and PTX groups, but both the mean iPTH level and the rate of iPTH levels of lower than 124 pg/mL were significantly lower in the PTX group than in the MWA group. The classical treatment for severe SHPT has been PTX, including total PTX, total PTX with autotransplantation, and subtotal PTX, all of which are effective for severe SHPT, improving the quality of life and decreasing the incidence of cardiovascular events and mortality [8,32,33]. MWA, a minimally invasive treatment, has been used to treat severe SHPT and good results have been achieved [20].…”