Total parathyroidectomy with forearm autotransplantation (tPTx+AT) may improve left ventricular hypertrophy (LVH) and systolic function among patients with end-stage kidney disease (ESKD).
In a retrospective study of 135 patients, parathyroid hormone levels fell from 2357 ng/mL before to 69.15 ng/mL 1 year after tPTx+AT. In addition, main ultrasonic cardiogram parameters dramatically improved, Shaohua Chen, MD, of the First Affiliated Hospital, Zhejiang University in China, and colleagues reported in BMC Nephrology. Left ventricular mass (LVM) significantly declined from 192.76 g before the procedure to 172.82 g at 1 year. Likewise, left ventricular mass index (LVMI) significantly declined from 123.54 to 107.01 g/m2. Of 80 patients diagnosed with LVH before PTx, 35 recovered after 1 year.
Furthermore, 35 patients with an ejection fraction of 60% or less prior to PTx experienced significant increases in ejection fraction (from 55.71% to 64.90%) and fractional shortening (from 29.54% to 35.48%) after 1 year. Of these patients, 29 also had a greater than 10% absolute improvement in left ventricular systolic function. Neither blood pressure improvement nor use of cardiovascular drugs accounted for the differences.
Dr Chen’s team concluded that tPTX+AT is an effective treatment for secondary hyperparathyroidism and appears to overturn LVH and improve left ventricular systolic function.
Chen S, Sheng K, Shen Y, et al. Impact of parathyroidectomy on left ventricular function in end stage renal disease patients. BMC Nephrol. 2020;21:479. doi:10.1186/s12882-020-02139-3