In hemodialysis (HD) patients with secondary hyperparathyroidism (SHPT), total parathyroidectomy (PTx) with autotransplantation can reduce calcification in the abdominal aorta associated with cardiovascular mortality, according to researchers.

Calcification scores fell significantly from 4 to 3 according to the abdominal aorta 24-score system within 1 year of successful surgery in 49 HD patients with SHPT, Fong-Fu Chou, MD, of Kaohsiung Chang Gung Memorial Hospital in Taiwan, and colleagues reported in the American Journal of Surgery. Calcification improved more in the surgery group than in a control group of 13 HD patients without SHPT, who saw no significant change.

The PTx group also experienced significant decreases in median serum intact parathyroid hormone (from 1188 to 48.1 pg/mL), calcium (from 10.3 to 9.2 mg/dL), phosphate (from 5.9 to 4.7 mg/dL), alkaline phosphatase (from 140 to 75 U/L), and fibroblast growth factor 23 (from 54 to 42 ng/mL) levels within a year of surgery. Meanwhile, serum Klotho increased from 703 to 820 pg/mL. The control group had no meaningful changes during the study period, except for a dip in FGF23 (from 35 to 31.9 ng/mL), possibly due to cinacalcet or sevelamer therapy.

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“Fibroblast growth factor-23 (FGF23) and the Klotho endocrine axis have an important role in mineral metabolism,” Dr Chou and the team explained. “FGF23 increases in the blood of chronic kidney disease patients, and elevation of FGF23 levels is associated with higher vascular and aortic calcification in hemodialysis patients.”

According to the authors, this is the first study to examine abdominal aortic calcification scores after total parathyroidectomy plus autotransplantation in this population.

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Chou FF, Chen JB, Huang SC, Chan YC, Chi SY, Chen WT. Changes in serum FGF23 and Klotho levels and calcification scores of the abdominal aorta after parathyroidectomy for secondary hyperparathyroidism. Am J Surg. DOI:10.1016/j.amjsurg.2018.12.026