Parathyroidectomy reduces cardiovascular events and mortality in renal hyperparathyroidism

被引:90
作者
Costa-Hong, Valeria
Jorgetti, Vanda
Gowdak, Luis Henrique W.
Moyses, Rosa Maria A.
Krieger, Eduardo M.
De Lima, Jose Jayme G.
机构
[1] Inst Heart, Hypertens Unit, Dept Nephrol, BR-05403000 Sao Paulo, Brazil
[2] Univ Sao Paulo, Hosp & Clin, Sch Med, Sao Paulo, Brazil
基金
巴西圣保罗研究基金会;
关键词
D O I
10.1016/j.surg.2007.06.015
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background. Secondary hyperparathyroidism (SHPT) and its associated abnormalities in mineral metabolism increase the risk of cardiovascular morbidity and death in chronic renal failure (CRF). The effect of parathyroidectomy (PTX) on the incidence of major cardiovascular events in CRF, patients with SHPT is unknown. We tested the hypothesis that PTX reduces the incidence of cardiovascular complications and death in CPY patients with severe SHPT scheduled for PTX, comparing the outcome of Patients treated or not treated by PTX. Methods. The study comprised 118 CRF patients with SHPT on maintenance hemodialysis, unresponsive to medical treatment and scheduled for PTX. Patients underwent comprehensive cardiovascular evaluations at baseline. They were followed up until death, occurrence of major cardiovascular events, or kidney transplantation. Results. No deaths related to PTX occurred. After a median follow-up of 30 months, 50 patients (42 %) had undergone PTX whereas 68 (58 %) had not. The groups were comparable in terms of age, sex, race, serum parathyroid hormone, calcium or phosphate, calcium x phosphate product, and all major cardiovascular variables, except diastolic blood pressure. PTX was associated with a reduced incidence of major cardiovascular events (P = .02) and overall mortality (P <= .001). Cox proportional multivariate analysis showed that variables associated independently with events were No-PTX (RR = 2.36, CI 1.11-6.32, P =.02) and age (RR = 1.0 7, IC 1. 02-1.14, P = .009). All cause mortality was related to No-PTX (RR- = 2.34, CI 1.25-5.14, P = .007) and hematocrit (RR 1.15, CI 1.03-1.29, P =.01). Conclusion. PTX confers protection against future major cardiovascular events and death in select CRF patients with severe refractory SHPT.
引用
收藏
页码:699 / 703
页数:5
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