International Urology and Nephrology

, Volume 50, Issue 12, pp 2279–2288 | Cite as

Effects of parathyroidectomy on blood bone markers and heart rate variability in patients with stage 5 chronic kidney disease

  • Huimin Chen
  • Ying Cui
  • Changying Xing
  • Yogendranath Purrunsing
  • Xiaoming Zha
  • Chong Shen
  • Ming Zeng
  • Guang Yang
  • Xiangbao Yu
  • Lina Zhang
  • Yao Jiang
  • Zhixiang Shen
  • Haoyang Ma
  • Caixia Yin
  • Yunfei LiEmail author
  • Ningning WangEmail author
Nephrology - Original Paper



Decreased heart rate variability (HRV) is closely related to abnormal cardiac autonomic nervous function, especially sympathetic hyperactivity, which intensifies the risk of cardiovascular events and sudden death. HRV parameters are lower in chronic kidney disease (CKD) and parathyroidectomy (PTX) can improve these abnormalities in severe secondary hyperparathyroidism (SHPT) patients. However, few studies have evaluated correlations between circulating bone markers and HRV in CKD patients.


We conducted a cross-sectional study including 134 stage 5 CKD patients with 100 controls and a prospective study of 29 PTX patients with follow-up. Circulating bone biomarkers included: (1) intact parathyroid hormone (iPTH) as bone remodeling regulator; (2) bone-specific alkaline phosphatase (BAP), representing bone formation; (3) tartrate-resistant acid phosphatase 5b (TRACP-5b), indicating bone resorption; and (4) bone-derived hormone, fibroblast growth factor 23 (FGF23).


Stage 5 CKD patients had higher circulating iPTH, BAP, TRACP-5b, and FGF23 than controls and these bone markers were significantly elevated in SHPT patients. Baseline iPTH, BAP, and lnFGF23 were independently associated with HRV in CKD patients. After PTX with a follow-up (median interval: 6.7 months), high blood iPTH, BAP, TRACP-5b, FGF23, and attenuated HRV were ameliorated. Furthermore, improved HRV indices were associated with reduced iPTH, BAP, TRACP-5b, and FGF23.


Circulating bone markers are correlated with HRV in CKD 5 patients and PTX can improve decreased HRV, which are associated with corrected bone markers in severe SHPT patients. Thus, we propose that PTH increases sympathetic tone and both high circulating PTH levels and sympathetic hyperactivity increase bone turnover, and that the products of bone turnover influence HRV.


Chronic kidney disease-mineral and bone disorder Bone markers Heart rate variability Parathyroidectomy Secondary hyperparathyroidism 



The authors would like to thank Qing Ma and Yanyan Pan for the care and management of the patients; Yun Xia, Zhihui Song, Jing Tu and Saijun Yang for assistance with the analysis of heart rate variability. This work was funded by the National Natural Science Foundation of China (81270408, 81570666), International Society of Nephrology (ISN) Clinical Research Program (18-01-0247), Construction Program of Jiangsu Provincial Clinical Research Center Support System (BL2014084), Chinese Society of Nephrology (13030300415), Jiangsu Province Key Medical Personnel Project (RC201162, ZDRCA2016002), and Six Major Talents Summit of Jiangsu Province ([2010-WS-026]).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.


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Copyright information

© Springer Nature B.V. 2018

Authors and Affiliations

  • Huimin Chen
    • 1
  • Ying Cui
    • 1
  • Changying Xing
    • 1
  • Yogendranath Purrunsing
    • 1
  • Xiaoming Zha
    • 2
  • Chong Shen
    • 3
  • Ming Zeng
    • 1
  • Guang Yang
    • 1
  • Xiangbao Yu
    • 1
  • Lina Zhang
    • 1
  • Yao Jiang
    • 1
  • Zhixiang Shen
    • 4
  • Haoyang Ma
    • 1
  • Caixia Yin
    • 1
  • Yunfei Li
    • 5
    Email author
  • Ningning Wang
    • 1
    Email author
  1. 1.Department of Nephrology, The First Affiliated Hospital of Nanjing Medical UniversityJiangsu Province HospitalNanjingPeople’s Republic of China
  2. 2.Department of General Surgery, The First Affiliated Hospital of Nanjing Medical UniversityJiangsu Province HospitalNanjingPeople’s Republic of China
  3. 3.Department of Epidemiology and Biostatistics, School of Public HealthNanjing Medical UniversityNanjingPeople’s Republic of China
  4. 4.Department of NephrologyJiangsu Province Geriatric HospitalNanjingPeople’s Republic of China
  5. 5.Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical UniversityJiangsu Province HospitalNanjingPeople’s Republic of China

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