Hemodialysis (HD) patients who undergo parathyroidectomy for severe, uncontrolled secondary hyperparathyroidism (SHPT) are at significantly lower risk for all-cause and cardiovascular mortality, according to a Japanese study.
In a retrospective study, Hirotaka Komaba, MD, of Tokai University School of Medicine in Isehara, and colleagues compared 4,429 HD patients with severe SHPT who underwent a parathyroidectomy and 4,428 propensity score-matched HD patients who did not despite severe SHPT. The 1-year all-cause and cardiovascular mortality rates was 4.3% and 1.8% in the parathyroidectomy group, respectively, compared with 6.5% and 3.1%, respectively, in the matched control group, the investigators reported in Kidney International (2015;88:350-359). In a fully adjusted model, the parathyroidectomy patients had a 22% and 29% lower risk of all-cause and cardiovascular mortality during a 1-year follow-up, respectively, compared with the matched controls.
The researchers acknowledged that only a randomized controlled trial could definitively determine the survival benefit of parathyroidectomy. In light of the apparent clinical effects of parathyroidectomy on SHPT-related symptoms, however, conducting such trials in patients with uncontrolled, severe SHPT would be viewed as unethical. “Given this, our findings have important implications in the management of severe SHPT and provide an additional basis to support the current international or national guidelines that suggest or recommend [parathyroidectomy] for patients with refractory SHPT,” the authors concluded. “