Elsevier

Kidney International

Volume 88, Issue 2, August 2015, Pages 350-359
Kidney International

Clinical Investigation
Parathyroidectomy and survival among Japanese hemodialysis patients with secondary hyperparathyroidism

https://doi.org/10.1038/ki.2015.72Get rights and content
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Parathyroidectomy (PTx) drastically improves biochemical parameters and clinical symptoms related to severe secondary hyperparathyroidism (SHPT) but the effect of PTx on survival has not been adequately investigated. Here we analyzed data on 114,064 maintenance hemodialysis patients from a nationwide registry of the Japanese Society for Dialysis Therapy to evaluate the associations of severity of SHPT and history of PTx with 1-year all-cause and cardiovascular mortality. We then compared the mortality rate between 4428 patients who had undergone PTx and 4428 propensity score–matched patients who had not despite severe SHPT. During a 1-year follow-up, 7926 patients of the entire study population died, of whom 3607 died from cardiovascular disease. Among patients without a history of PTx, severe SHPT was associated with an increased risk for all-cause and cardiovascular mortality. However, such an increased risk of mortality was not observed among patients with a history of PTx. In the propensity score–matched analysis, patients who had undergone PTx had a 34% and 41% lower risk for all-cause and cardiovascular mortality, respectively, compared to the matched controls. The survival benefit associated with PTx was robust in several sensitivity analyses and consistent across subgroups, except for those who had persistent postoperative SHPT. Thus, successful PTx may reduce the risk for all-cause and cardiovascular mortality in hemodialysis patients with severe, uncontrolled SHPT.

KEYWORDS

hemodialysis
hyperparathyroidism
parathyroid hormone
survival

Cited by (0)

HK has received honoraria and/or consulting fees from Bayer Yakuhin and Kyowa Hakko Kirin. MT has received consulting fees from Kyowa Hakko Kirin. KI has received honoraria and/or consulting fees from Astellas Pharma, Bayer Yakuhin, Chugai Pharmaceutical, Daiichi Sankyo, Kyowa Hakko Kirin, Merck Sharp & Dohme Corp., Mochida Pharmaceutical, Teijin Pharma, and Torii Pharmaceutical. YT has received honoraria, consulting fees, and/or grant/research support from Asahi Kasei Medical, Astellas Pharma, Baxter, Bayer Yakuhin, Chugai Pharmaceutical, Fuso Pharmaceutical Industries, GlaxoSmithKline K.K., Kissei Pharmaceutical, Kyowa Hakko Kirin, Mitsubishi Tanabe Pharma, Nippon Boehringer Ingelheim, Otsuka Pharmaceutical, Shionogi Pharmaceutical, Taisho Pharmaceutical, Takeda Pharmaceutical, Teijin Pharma, and Torii Pharmaceutical. MF has received honoraria, consulting fees, and/or grant/research support from Astellas Pharma, Bayer Yakuhin, Kyowa Hakko Kirin, Ono Pharmaceutical, and Torii Pharmaceutical. AW declared no competing interests.