Survival after Parathyroidectomy in Patients with End‐stage Renal Disease and Severe Hyperparathyroidism

Trombetti, Andrea; Stoermann, C.; Robert, John; Herrmann, Françoís; Pennisi, P.; Martin, Pierre‐Yves; Rizzoli, René

doi:10.1007/s00268-006-0693-1

Cited by 53 publications

(48 citation statements)

References 56 publications

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“…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%.…”

Section: Selection and Characteristics Of Studiesmentioning

confidence: 99%

“…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.…”

Section: Selection and Characteristics Of Studiesmentioning

confidence: 99%

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

Chen

Wang

et al. 2016

Renal Failure

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Parathyroidectomy (PTx) and medical treatments are both recommended for reducing serum intact parathyroid hormone (iPTH) and curing secondary hyperparathyroidism (sHPT) in patients with chronic kidney disease (CKD), but their therapeutic effects on long-term mortality are not well-known. Thus, we aim to assess such therapeutic effect of PTx. Electronic literatures published on Pubmed, Embase, and Cochrane Central Register of Controlled Trials in any language until 27 November 2015 were systematically searched. All literatures that compared outcomes (survival rate or mortality rate) between PTx-treated and medically-treated CKD patients with sHPT were included. Finally, 13 cohort studies involving 22053 patients were included. Data were extracted from all included literatures in a standard form. The outcomes of all-cause and cardiovascular mortalities were assessed using DerSimonian and Laird's random effects model. We find PTx-treated versus medically-treated patients had a 28% reduction in all-cause mortality and a 37% reduction in cardiovascular mortality. Thus, PTx versus medical treatments might reduce the risks of all-cause and cardiovascular mortalities in CKD patients with sHPT. Further studies with prospective and large-sample clinical trials are needed to find out the real effect of PTx and to assess whether mortality rates differ among patterns of PTx. ARTICLE HISTORY

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Section: Selection and Characteristics Of Studiesmentioning

confidence: 99%

Section: Selection and Characteristics Of Studiesmentioning

confidence: 99%

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

Chen

Wang

et al. 2016

Renal Failure

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“…KDIGO guidelines currently state that patients with CKD stages 3-5D with severe hyperparathyroidism who fail to respond to medical therapy should undergo parathyroidectomy. This recommendation may have been based on observational, not-randomized clinical trial evidence describing potentially beneficial effects on short-term laboratory parameters and/or on longer-term clinical outcomes including fracture and death (5,6). Some (7)(8)(9)(10)(11)(12) but not all (5) reports suggest that short-term adverse outcomes related to parathyroidectomy produce only modest adverse consequences.…”

Section: Introductionmentioning

confidence: 99%

Clinical Outcomes after Parathyroidectomy in a Nationwide Cohort of Patients on Hemodialysis

Ishani

Liu

Wetmore

et al. 2015

Clinical Journal of the American Society of Nephrology

126

122

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Background and objectives Patients receiving dialysis undergo parathyroidectomy to improve laboratory parameters in resistant hyperparathyroidism with the assumption that clinical outcomes will also improve. However, no randomized clinical trial data demonstrate the benefits of parathyroidectomy. This study aimed to evaluate clinical outcomes up to 1 year after parathyroidectomy in a nationwide sample of patients receiving hemodialysis.Design, setting, participants, & measurements Using data from the US Renal Data System, this study identified prevalent hemodialysis patients aged $18 years with Medicare as primary payers who underwent parathyroidectomy from 2007 to 2009. Baseline characteristics and comorbid conditions were assessed in the year preceding parathyroidectomy; clinical events were identified in the year preceding and the year after parathyroidectomy. After parathyroidectomy, patients were censored at death, loss of Medicare coverage, kidney transplant, change in dialysis modality, or 365 days. This study estimated cause-specific event rates for both periods and rate ratios comparing event rates in the postparathyroidectomy versus preparathyroidectomy periods.Results Of 4435 patients who underwent parathyroidectomy, 2.0% died during the parathyroidectomy hospitalization and the 30 days after discharge. During the 30 days after discharge, 23.8% of patients were rehospitalized; 29.3% of these patients required intensive care. In the year after parathyroidectomy, hospitalizations were higher by 39%, hospital days by 58%, intensive care unit admissions by 69%, and emergency room/ observation visits requiring hypocalcemia treatment by 20-fold compared with the preceding year. Causespecific hospitalizations were higher for acute myocardial infarction (rate ratio, 1.98; 95% confidence interval, 1.60 to 2.46) and dysrhythmia (rate ratio 1.4; 95% confidence interval1.16 to 1.78); fracture rates did not differ (rate ratio 0.82; 95% confidence interval 0.6 to 1.1).Conclusions Parathyroidectomy is associated with significant morbidity in the 30 days after hospital discharge and in the year after the procedure. Awareness of clinical events will assist in developing evidence-based risk/benefit determinations for the indication for parathyroidectomy.

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“…One study found that short-term mortality in end-stage renal dialysis (ESRD) patients was higher following parathyroidectomy, although long-term mortality was lower [20]. Mortality may be increased in those who are older and/or have more comorbidities [21]. …”

Section: Introductionmentioning

confidence: 99%

Comparative Effectiveness of Paricalcitol versus Cinacalcet for Secondary Hyperparathyroidism in Patients Receiving Hemodialysis

et al. 2010

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Background/Aims: Parathyroidectomies are performed when medical therapy fails to control secondary hyperparathyroidism in hemodialysis patients. The objective of this study was to compare parathyroidectomy rates in secondary hyperparathyroidism patients treated with paricalcitol or cinacalcet. Methods: Retrospective cohort study using health insurance claims from January 2001 through June 2007 for adult hemodialysis patients who were new users of paricalcitol or cinacalcet. Subjects had a minimum of 12 months’ enrollment prior to initiation of treatment and at least 30-day follow-up. Results: We identified 1,387 paricalcitol- and 1,317 cinacalcet-treated patients. The parathyroidectomy incident rate was 74% lower in the paricalcitol (0.58 per 100 patient-years) compared to the cinacalcet (2.24 per 100 patient-years) cohort, with an unadjusted rate ratio of 0.26 (95% CI 0.12–0.52). The time to parathyroidectomy from medication initiation was longer for paricalcitol than cinacalcet; however, it was not statistically significant (535 vs. 443 days, p = 0.377). A Cox proportional hazard model that adjusted for age, gender, obesity, significantly different comorbidities, and duration of hemodialysis resulted in an adjusted risk reduction for parathyroidectomy of 79% (HR = 0.21, 95% CI 0.10–0.46) for paricalcitol compared to cinacalcet. Conclusion: These data suggest that long-term treatment with paricalcitol is associated with fewer parathyroidectomies when compared to cinacalcet. Further comparative studies are needed to validate these results.

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Survival after Parathyroidectomy in Patients with End‐stage Renal Disease and Severe Hyperparathyroidism

Abstract: The risk of death of patients with severe SHPT leading to PTX differed from that of nonoperated subjects. The apparent differences in survival may be related to the number and severity of associated comorbidities. ESRD patients who undergo PTX may represent a subset of healthier subjects.

Cited by 53 publications

References 56 publications

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

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

Clinical Outcomes after Parathyroidectomy in a Nationwide Cohort of Patients on Hemodialysis

Comparative Effectiveness of Paricalcitol versus Cinacalcet for Secondary Hyperparathyroidism in Patients Receiving Hemodialysis

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