Document Detail


Improved long-term survival of dialysis patients after near-total parathyroidectomy.
MedLine Citation:
PMID:  22463880     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Severe secondary hyperparathyroidism, which is associated with life-threatening complications, can develop in dialysis-dependent end-stage renal disease patients. The aim of this study was to compare short- and long-term mortality in dialysis patients who underwent near-total parathyroidectomy (NTPTX) and matched nonoperated controls.
STUDY DESIGN: We identified 150 dialysis patients who underwent NTPTX (1993-2009) at our institution and compared them with 1,044 nonoperated control patients identified in the US Renal Data System registry, matched for age, sex, race, diabetes as cause of kidney failure, years on dialysis, and dialysis modality. Survival outcomes were estimated using multivariable Cox proportional hazards models with stratification on the matching sets, adjusted for cardiovascular comorbidities, smoking, inability to ambulate/transfer, and payor status.
RESULTS: During a follow-up of a mean of 3.6 years (range 0.1 month to 16.4 years), NTPTX patients had a significant reduction in the long-term risk of all-cause death (hazard ratio = 0.68; 95% CI, 0.52-0.89; p = 0.006) compared with controls. Thirty-day mortality rates for NTPTX patients and controls were 246 vs 105 per 1,000 person-years (p = 0.21). In adjusted analyses, NTPTX patients had a 37% reduced risk of all-cause death and a 33% reduced risk of cardiovascular death compared with controls. A durable reduction in mean parathyroid hormone was observed after NTPTX; from 1,776 ± 1,416.6 pg/mL to 301 ± 285.7 pg/mL (p < 0.0001).
CONCLUSIONS: In our center, NTPTX in dialysis patients was associated with a significant reduction in long-term risk of death compared with matched control patients, without a significantly increased short-term risk.
Authors:
Jyotirmay Sharma; Paolo Raggi; Nancy Kutner; James Bailey; Rebecca Zhang; Yijian Huang; Charles A Herzog; Collin Weber
Publication Detail:
Type:  Evaluation Studies; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American College of Surgeons     Volume:  214     ISSN:  1879-1190     ISO Abbreviation:  J. Am. Coll. Surg.     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-04-02     Completed Date:  2012-07-27     Revised Date:  2014-04-11    
Medline Journal Info:
Nlm Unique ID:  9431305     Medline TA:  J Am Coll Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  400-7; discussion 407-8     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2012 American College of Surgeons. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Adult
Female
Follow-Up Studies
Humans
Hyperparathyroidism, Secondary / blood,  etiology,  mortality,  surgery*
Kaplan-Meier Estimate
Kidney Failure, Chronic / complications,  mortality,  therapy*
Male
Middle Aged
Parathyroid Hormone / blood
Parathyroidectomy / methods*
Proportional Hazards Models
Renal Dialysis*
Retrospective Studies
Survival Rate
Treatment Outcome
Grant Support
ID/Acronym/Agency:
HHSN267200715004C//PHS HHS; N01-DK-7-5004/DK/NIDDK NIH HHS; UL1 RR025008/RR/NCRR NIH HHS
Chemical
Reg. No./Substance:
0/Parathyroid Hormone

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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