Parathyroidectomy (PTx) is associated with higher cardio- and cerebrovascular risks in dialysis patients but lower risks in transplant recipients, according to a new study.

Using the Swedish renal registry, Kerstin M. Ivarsson, PhDc, of Lund University and colleagues identified 579 patients who underwent PTx for secondary hyperparathyroidectomy, including 423 patients receiving hemodialysis or peritoneal dialysis and 156 transplant recipients with a functioning renal allograft. Medical records spanned from 1991 to 2009, before and after the introduction of calcimimetics. PTx patients were matched by age, sex, and cause of end-stage renal disease to 1234 dialysis and 736 kidney transplant patients who did not undergo PTx.

Dialysis patients who underwent PTx had a 24% greater risk for myocardial infarction, stroke, and transient ischemic attack than their counterparts who did not undergo PTx, according to results published in the World Journal of Surgery. Dialysis patients with diabetes, nephrosclerosis, or pyelonephritis who underwent PTx had double the risks for the composite endpoint than those with autosomal dominant polycystic kidney disease. Renal allograft patients had a 47% lower risk for the composite endpoint.

These findings run contrary to 4 previous registry-based studies suggesting PTx protects dialysis patients from cardio- and cerebrovascular events. The investigators believe differences may exist in overall health and social factors between patients on institutional dialysis vs peritoneal dialysis or home hemodialysis. With respect to transplant recipients, PTx was likely reserved for patients with severe SHPT, thereby skewing results.

The Swedish renal registry lacked data on parathyroid hormone, plasma calcium, phosphate, creatinine, BK and cytomegalovirus, new-onset diabetes, and relapse of kidney disease, which limits interpretation of the results.

Reference

Ivarsson KM, Akaberi S, Isaksson E, et al. Cardiovascular and cerebrovascular events after parathyroidectomy in patients on renal replacement therapy. World J Surg. DOI:10.1007/s00268-019-05020-z