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Parathyroidectomy improves cardiovascular outcome in nondiabetic dialysis patients with secondary hyperparathyroidism

Authors

  • Ho-Cheng Lin,

    1. Division of Nephrology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taipei, Taiwan
    2. School of Medicine, National Yang-Ming University, Taipei, Taiwan
    3. Division of Nephrology, Department of Internal Medicine, Kaohsiung Armed Force General Hospital, Kaohsiung, Taiwan
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  • Chien-Liang Chen,

    1. Division of Nephrology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taipei, Taiwan
    2. School of Medicine, National Yang-Ming University, Taipei, Taiwan
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  • Huey-Shyan Lin,

    1. Department of Health-Business Administration, School of Nursing, Fooyin University, Kaohsiung, Taiwan
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  • Kang-Ju Chou,

    1. Division of Nephrology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taipei, Taiwan
    2. School of Medicine, National Yang-Ming University, Taipei, Taiwan
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  • Hua-Chang Fang,

    1. Division of Nephrology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taipei, Taiwan
    2. School of Medicine, National Yang-Ming University, Taipei, Taiwan
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  • Shiuh-Inn Liu,

    1. School of Medicine, National Yang-Ming University, Taipei, Taiwan
    2. Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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  • Chih-Yang Hsu,

    1. Division of Nephrology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taipei, Taiwan
    2. School of Medicine, National Yang-Ming University, Taipei, Taiwan
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  • Wei-Chieh Huang,

    1. Division of Nephrology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taipei, Taiwan
    2. School of Medicine, National Yang-Ming University, Taipei, Taiwan
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  • Chien-Wei Huang,

    1. Division of Nephrology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taipei, Taiwan
    2. School of Medicine, National Yang-Ming University, Taipei, Taiwan
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  • Chun K. Huang,

    1. Division of Nephrology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taipei, Taiwan
    2. School of Medicine, National Yang-Ming University, Taipei, Taiwan
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  • Tsu-Yuan Chang,

    1. Division of Nephrology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taipei, Taiwan
    2. School of Medicine, National Yang-Ming University, Taipei, Taiwan
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  • Yun-Te Chang,

    1. School of Medicine, National Yang-Ming University, Taipei, Taiwan
    2. Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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  • Po-Tsang Lee

    Corresponding author
    1. Division of Nephrology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taipei, Taiwan
    2. School of Medicine, National Yang-Ming University, Taipei, Taiwan
    • Correspondence: Dr Po-Tsang Lee, Division of Nephrology Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Rd, Kaohsiung, Taiwan 813. Tel.: 886 7 3422121, ext 2050; Fax: 886 7 3455412; E-mail: ptlee@vghks.gov.tw

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Summary

Objective

Secondary hyperparathyroidism and its associated abnormalities in mineral metabolism and haemodynamic changes increase the cardiovascular risk in patients with end-stage renal disease (ESRD). Our objective was to determine the association of parathyroidectomy (PTX) with major cardiovascular events in nondiabetic dialysis patients with severe secondary hyperparathyroidism (SHPTH).

Design and Patients

We performed a cohort study with fifty-three nondiabetic ESRD patients who were treated with maintenance haemodialysis and who had intact parathyroid hormone (PTH) levels > 800 pg/ml. Participants received either only medical therapy or medical therapy and total PTX with autotransplantation for SHPTH.

Measurements

We evaluated the associations between PTX and major cardiovascular events including death, cerebrovascular accident and myocardial infarction. The biochemical and haemodynamic changes associated with PTX were measured.

Results

During the mean follow-up of 72 months, twenty-three patients received only medical treatment (medical group) while thirty patients underwent PTX in addition to medical treatment (PTX group). The two groups were comparable in respect of baseline characteristics. PTX group was found to be associated with a reduced incidence of major cardiovascular events (= 0·021). A multiple Cox regression analysis showed that the variable significantly associated with major cardiovascular events was treatment modality (medical therapy vs medical therapy and parathyroidectomy, hazard ratio = 26·12, 95% CI = 1·30–526·27, = 0·033). Blood pressure, haemoglobin, alkaline phosphatase, calcium, phosphate and calcium × phosphate product significantly improved after PTX.

Conclusions

PTX was associated with better cardiovascular outcome in nondiabetic dialysis patients with severe SHPTH.

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