Parathyroidectomy (PTx) may normalize a non-dipping heart rate pattern that is associated with death in patients with stage 5 chronic kidney disease (CKD), according to investigators.

Non-dipping is defined as a less than 10% reduction in mean heart rate from day-to-night or night-to-day, as measured by 24-hour Holter monitor. In a case-control study of 502 patients with stage 5 CKD (including those on dialysis) and 162 healthy individuals, the heart rate (HR) ratio was significantly higher in patients with CKD and met the criterion of non-dipping (ie, HR ratio greater than 0.90): 0.92 CKD vs 0.81 controls. Each 0.1 increment in non-dipping HR ratio was significantly associated with a significant 44% increase in mortality risk, Ningning Wang, MD, PhD, of The First Affiliated Hospital of Nanjing Medical University in Jiangsu, China, and colleagues reported in Endocrine Practice.

Non-dipping HR ratio significantly correlated with high serum intact parathyroid hormone (iPTH) levels, according to the investigators. Among a subgroup with secondary hyperparathyroidism (SHPT) and iPTH exceeding 500 pg/mL, 294 patients underwent total PTx with autotransplantation and 47 patients did not have surgery. PTx significantly normalized the non-dipping HR ratio over a median 6.3 months: night/day HR ratio significantly decreased from 0.93 before surgery to 0.88 after PTx, the team reported. Other parameters also improved: iPTH, serum phosphate, adjusted calcium, and alkaline phosphatase decreased, whereas hemoglobin and albumin increased.  Patients who underwent PTx had a significant 71% lower risk for all-cause mortality than those who did not have the surgery.

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Disturbed circadian rhythms, specifically non-dipping heart rate, may represent a novel prognostic marker for patients with CKD, according to Dr Wang’s team. PTx could attenuate this unfavorable diurnal variation in patients with SHPT, they stated, which appears to mediate better survival.


Cui Y, Huang H, Ren W, et al. Parathyroidectomy is associated with reversed non-dipping heart rate which impact mortality in chronic kidney disease patients. Published online February 18, 2021. Endocr Pract. doi:10.1016/j.eprac.2021.02.007