The effect of parathyroidectomy on patient survival in secondary hyperparathyroidism

Abstract

Background: Secondary hyperparathyroidism is a common condition in patients with end-stage renal disease and is associated with osteoporosis and cardiovascular disease. Despite improved medical treatment, parathyroidectomy (PTX) is still necessary for many patients on renal replacement therapy. The aim of this study was to evaluate the effect of PTX on patient survival.

Methods: A nested index-referent study was performed within the Swedish Renal Registry (SRR). Patients on maintenance dialysis and transplantation at the time of PTX were analysed separately. The PTX patients in each of these strata were matched for age, sex and underlying renal diseases with up to five referent patients who had not undergone PTX. To calculate survival time and hazard ratios, indexes and referents were assigned the calendar date (d) of the PTX of the index patient. The risk of death after PTX was calculated using crude and adjusted Cox proportional hazards regressions.

Results: There were 20 056 patients in the SRR between 1991 and 2009. Of these, 579 (423 on dialysis and 156 with a renal transplant at d) incident patients with PTX were matched with 1234/892 non-PTX patients. The adjusted relative risk of death was a hazard ratio (HR) of 0.80 [95% confidence interval (CI) 0.65-0.99] for dialysis patients at d who had undergone PTX compared with matched patients who had not. Corresponding results for the patients with a renal allograft at d were an HR of 1.10 (95% CI 0.71-1.70).

Conclusions: PTX was associated with improved survival in patients on maintenance dialysis but not in patients with renal allograft.

Keywords: PTH; dialysis; epidemiology; hyperparathyroidism; kidney transplantation; survival analysis.

FIGURE 1:

Kaplan–Meier survival estimate for PTX and non-PTX patients on dialysis at d, where d is the date of PTX or corresponding date for non-PTX patients.

FIGURE 2:

Kaplan–Meier survival estimates for PTX and non-PTX patients with functioning renal allograft at d, where d is the date of PTX or corresponding date for non-PTX patients.