Parathyroidectomy may reduce the risks for death and major adverse cardiovascular events in patients with secondary hyperparathyroidism receiving maintenance hemodialysis, a new study finds.
Investigators matched 75 patients who underwent parathyroidectomy with 75 patients who did not by age, sex, dialysis start, and a left ventricular ejection fraction of 30% or more. All had parathyroid hormone (PTH) levels exceeding 600 pg/mL, with the surgery group having significantly higher baseline levels (1673 vs 699 pg/mL). None had diabetes.
After either total parathyroidectomy with autotransplantation or subtotal parathyroidectomy, patients experienced rapid decreases in mean intact PTH and serum calcium and phosphorus levels. Their hemoglobin levels rose over time.
In adjusted analyses, parathyroidectomy significantly decreased the risk for death by 76%, Linna Liu, MD, of Guangzhou University of Chinese Medicine in Zhongshan, China, and colleagues reported in Renal Failure. The all-cause mortality rate was 2.9 vs 10.9 per 100 patient-years in the surgery vs no surgery group. Male sex, older age, and higher Charlson comorbidity index increased the risks for death.
The investigators also found a lower rate of major adverse cardiovascular and cerebrovascular events in the parathyroidectomy group: 6.7 vs 15.2 per 100 patient-years. The risk of a first major cardiovascular or cerebrovascular adverse event was reduced by a significant 48% with parathyroidectomy. Events included cerebral hemorrhage, stroke, heart failure, myocardial infarction, unstable angina, peripheral vascular events, and sudden death.
Hospitalization rates were also significantly lower in the surgery group: 50.3 vs 66.5 per 100 patient-years, the investigators reported. They did not find a reduction in fracture risk.
“[Parathyroidectomy] may be considered a therapy of priority in centers with high-quality surgical experience and follow-up team,” according to Dr Liu’s team.
Huanga Q, Panga J, Shib C, et al. Impact of parathyroidectomy among nondiabetic hemodialysis patients with severe hyperparathyroidism. Renal Failure 44(1):1160–1168. doi:10.1080/0886022X.2022.2098768