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

Trombetti, Andrea ; Stoermann, Catherine ; Robert, John ; Herrmann, François ; Pennisi, Pietra ; Martin, Pierre-Yves ; Rizzoli, René

In: World Journal of Surgery, 2007, vol. 31, no. 5, p. 1014-1021

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    Titre
    • Survival after Parathyroidectomy in Patients with End-stage Renal Disease and Severe Hyperparathyroidism
    Auteur
    • Trombetti, Andrea. Service of Bone Diseases (WHO Collaborating Center for Osteoporosis Prevention), Department of Rehabilitation and Geriatrics, University Hospital of Geneva, 1211, Geneva 14, Switzerland
    • Stoermann, Catherine. Service of Nephrology, Department of Internal Medicine, University Hospital of Geneva, 1211, Geneva 14, Switzerland
    • Robert, John. Thoracic Surgery Unit, Department of Surgery, University Hospital of Geneva, 1211, Geneva 14, Switzerland
    • Herrmann, François. Service of Bone Diseases (WHO Collaborating Center for Osteoporosis Prevention), Department of Rehabilitation and Geriatrics, University Hospital of Geneva, 1211, Geneva 14, Switzerland
    • Pennisi, Pietra. Service of Bone Diseases (WHO Collaborating Center for Osteoporosis Prevention), Department of Rehabilitation and Geriatrics, University Hospital of Geneva, 1211, Geneva 14, Switzerland
    • Martin, Pierre-Yves. Service of Nephrology, Department of Internal Medicine, University Hospital of Geneva, 1211, Geneva 14, Switzerland
    • Rizzoli, René. Service of Bone Diseases (WHO Collaborating Center for Osteoporosis Prevention), Department of Rehabilitation and Geriatrics, University Hospital of Geneva, 1211, Geneva 14, Switzerland
    Type de document
    • Postprint
    Langue
    • Inglese
    Publié dans
    • World Journal of Surgery, 2007, vol. 31, no. 5, p. 1014-1021. Springer-Verlag
    Autre version électronique
    Classification
    • Santé
    Identifiant OAI-PMH
    • oai:doc.rero.ch:313881
    Summary
    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