World Journal of Endocrine Surgery

Register      Login

VOLUME 8 , ISSUE 3 ( September-December, 2016 ) > List of Articles

RESEARCH ARTICLE

Parathyroidectomy in Dialysis Patients: What is the Risk?

Jamie E Anderson, Jennifer L Olson, Michael J Campbell

Citation Information : Anderson JE, Olson JL, Campbell MJ. Parathyroidectomy in Dialysis Patients: What is the Risk?. World J Endoc Surg 2016; 8 (3):193-198.

DOI: 10.5005/jp-journals-10002-1190

Published Online: 00-12-2016

Copyright Statement:  Copyright © 2016; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Aims

Patients with chronic kidney disease (CKD) on dialysis commonly develop hyperparathyroidism (HPT), but are often not referred for surgical evaluation because of the belief that the cardiopulmonary risks of a parathyroidectomy are prohibitively high. Previous studies have not adequately determined the surgical risks of parathyroidectomy in this population.

Materials and methods

We used the American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2013 to evaluate risk of complications for dialysis vs nondialysis patients undergoing parathyroidectomy using univariate and multivariate logistic regressions. We also compared outcomes between dialysis patients undergoing parathyroidectomy and arteriovenous fistula (AVF) creation to understand the relative risk between these procedures.

Results

A total of 28,438 patients underwent parathyroidectomy; 1,833 (6.5%) were on dialysis. Among patients undergoing parathyroidectomy, unadjusted mortality and complication rates were higher for patients on dialysis compared to those not on dialysis (1.4% vs 0.1%, p < 0.001; 7.9% vs 1.4%, p < 0.001). Multivariate analysis found increased odds of mortality, all complications, and cardiopulmonary complications among patients on dialysis compared to those not on dialysis [odds ratio (OR) 5.28, p = 0.004; 2.10, p < 0.001; 5.14, p < 0.001]. When compared to patients undergoing parathyroidectomy, dialysis patients undergoing AVF had no difference in odds of death (p = 0.392) or cardiopulmonary complications (p = 0.138), but did have an increased risk of any complication (OR 1.66, p = 0.035).

Conclusion

Dialysis patients undergoing parathyroidectomy have an increased risk of cardiopulmonary complications and mortality compared to patients not on dialysis; however, these risks are similar to patients undergoing AVF creation. The risks of parathyroidectomy in dialysis patients are likely similar to other commonly performed procedures for dialysis patients.

Clinical significance: The risk of mortality and complications should be discussed during informed consent with dialysis patients undergoing parathyroidectomy. These findings can also assist in preoperative risk assessments.

How to cite this article

Anderson JE, Olson JL, Campbell MJ. Parathyroidectomy in Dialysis Patients: What is the Risk? World J Endoc Surg 2016;8(3):193-198.


PDF Share
  1. S. Department of Health and Human Services. National Institute of Diabetes and Digestive and Kidney Diseases. “Kidney Disease Statistics for the United States” [cited 21 October 2015]. Available from: http://www.niddk.nih.gov/health-information/health-statistics/Pages/kidney-diseasestatistics-united-states.aspx#3.
  2. Prevalence of abnormal serum vitamin D, PTH, calcium, and phosphorus in patients with chronic kidney disease: results of the study to evaluate early kidney disease. Kidney Int 2007 Jan;71(1):31-38.
  3. Hyperparathyroidism. Lancet 2009 Jul;374(9684):145-158.
  4. Metabolic bone disease in chronic kidney disease. J Am Soc Nephrol 2007 Mar;18(3):875-885.
  5. The consequences of uncontrolled secondary hyperparathyroidism and its treatment in chronic kidney disease. Semin Dial 2004 May-Jun;17(3):209-216.
  6. Risk of major nonemergent inpatient general surgical procedures in patients on long-term dialysis. JAMA Surg 2013 Feb;148(2):137-143.
  7. KDOQI Clinical practice guidelines for bone metabolism and disease in children with chronic kidney disease [cited 21 October 2015]. Available from: http://www2.kidney.org/professionals/kdoqi/guidelines_pedbone/guide15.htm.
  8. Parathyroidectomy reduces cardiovascular events and mortality in renal hyperparathyroidism. Surgery 2007 Nov;142(5):699-703.
  9. Survival following parathyroidectomy among United States dialysis patients. Kidney Int 2004 Nov;66:2010-2016.
  10. Improved long-term survival of dialysis patients after near-total parathyroidectomy. J Am Coll Surg 2012 Apr;214(4):400-407.
  11. Parathyroidectomy versus cinacalcet hydrochloride-based medical therapy in the management of hyperparathyroidism in ESRD: a cost utility analysis. Am J Kidney Dis 2007 Jun;49(6):801-813.
  12. An economic comparison of surgical and medical therapy in patients with secondary hyperparathyroidism— the German perspective. Surgery 2010 Dec;148(6):1091-1099.
  13. ACS NSQIP participant use data file [cited 14 October 2015]. Available from: https://www.facs.org/quality-programs/acs-nsqip/program-specifics/participant-use.
  14. Clinical outcomes after parathyroidectomy in a nationwide cohort of patients. Clin J Am Soc Nephrol 2015 Jan;10(1):90-97.
  15. Total parathyroidectomy improves survival of hemodialysis patients with secondary hyperparathyroidism. J Nephrol 2012 Sep-Oct;25(5):755-763.
  16. Parathyroidectomy improves survival in patients with severe hyperparathyroidism: a comparative study. PLoS One 2013 Aug;8(8):e68870.
  17. The effect of parathyroidectomy on patient survival in secondary hyperparathyroidism. Nephrol Dial Transplant 2015 Dec;30(12):2027-2033.
  18. Parathyroidectomy improves cardiovascular outcome in nondiabetic dialysis patients with secondary hyperparathyroidism. Clin Endocrinol 2014 Apr;80(4):508-515.
  19. Reduced stroke risk after parathyroidectomy in end-stage renal disease: a 13 years population-based cohort study. Medicine 2015 Jun;94(23):e936.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.