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Survival after Parathyroidectomy in Patients with End-stage Renal Disease and Severe Hyperparathyroidism

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Abstract

Background

Patients with end-stage renal disease (ESRD) and secondary hyperparathyroidism (SHPT) are at high risk of mortality. Whether an increased risk of death persists after a parathyroidectomy (PTX) is not clearly established.

Subjects and methods

The survival of 40 patients with ESRD and SHPT who underwent PTX was compared with that of 664 ESRD patients.

Results

From first dialysis, a lower mortality rate was found in the group of patients who underwent PTX than in the nonoperated ESRD group (hazard ratio: 0.23; 95% CI: 0.14–0.37). The patients who underwent PTX were younger, had a longer time on dialysis, and had a higher prevalence of kidney transplantation. The mean number of comorbidities was lower (Charlson score 4.2 ± 2.1 versus 6.4 ± 2.9, p < 0.001). Then, we randomly selected two matched controls for each PTX case (80 controls, 40 PTX) who had at least an equivalent mean duration of dialysis between the first dialysis and PTX of the PTX group. In a univariate model, there was a trend for PTX being associated with prolonged survival. The mortality was higher both among those at an advanced age and those with a high Charlson score. Adjustments for these covariates made the effect of PTX no more significant.

Conclusions

The risk of death of patients with severe SHPT leading to PTX differed from that of nonoperated subjects. The apparent differences in survival may be related to the number and severity of associated comorbidities. ESRD patients who undergo PTX may represent a subset of healthier subjects.

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ACKNOWLEDGMENTS

The authors acknowledge the editorial assistance of Mrs Marianne Perez and Mrs Praveen Bhalla.

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Authors and Affiliations

  1. Service of Bone Diseases (WHO Collaborating Center for Osteoporosis Prevention), Department of Rehabilitation and Geriatrics, University Hospital of Geneva, 1211, Geneva 14, Switzerland

    Andrea Trombetti MD, François R. Herrmann MD, Pietra Pennisi MD & René Rizzoli MD

  2. Service of Nephrology, Department of Internal Medicine, University Hospital of Geneva, 1211, Geneva 14, Switzerland

    Catherine Stoermann MD & Pierre-Yves Martin MD

  3. Thoracic Surgery Unit, Department of Surgery, University Hospital of Geneva, 1211, Geneva 14, Switzerland

    John H. Robert MD

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  1. Andrea Trombetti MD
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  2. Catherine Stoermann MD
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  3. John H. Robert MD
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  4. François R. Herrmann MD
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  5. Pietra Pennisi MD
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  6. Pierre-Yves Martin MD
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Correspondence to Andrea Trombetti MD.

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Trombetti, A., Stoermann, C., Robert, J.H. et al. Survival after Parathyroidectomy in Patients with End-stage Renal Disease and Severe Hyperparathyroidism. World J Surg 31, 1014–1021 (2007). https://doi.org/10.1007/s00268-006-0693-1

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  • DOI: https://doi.org/10.1007/s00268-006-0693-1

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