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Parathyroidectomy and survival in a cohort of Italian dialysis patients: results of a multicenter, observational, prospective study

BACKGROUND: Severe secondary hyperparathyroidism (SHPT) is associated with mortality in end stage kidney disease (ESKD). Parathyroidectomy (PTX) becomes necessary when medical therapy fails, thus highlighting the interest to compare biochemical and clinical outcomes of patients receiving either medi...

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Autores principales: Tartaglione, Lida, Rotondi, Silverio, Aucella, Filippo, Bonomini, Mario, Caruso, Maria Rosa, Casino, Francesco, Cuzziol, Carlo, Farcomeni, Alessio, Filippini, Armando, Lomonte, Carlo, Marinelli, Rocco, Rolla, Davide, Rubino, Filomena, Seminara, Giuseppe, Pasquali, Marzia, Mazzaferro, Sandro
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10543527/
https://www.ncbi.nlm.nih.gov/pubmed/37351832
http://dx.doi.org/10.1007/s40620-023-01658-0
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author Tartaglione, Lida
Rotondi, Silverio
Aucella, Filippo
Bonomini, Mario
Caruso, Maria Rosa
Casino, Francesco
Cuzziol, Carlo
Farcomeni, Alessio
Filippini, Armando
Lomonte, Carlo
Marinelli, Rocco
Rolla, Davide
Rubino, Filomena
Seminara, Giuseppe
Pasquali, Marzia
Mazzaferro, Sandro
author_facet Tartaglione, Lida
Rotondi, Silverio
Aucella, Filippo
Bonomini, Mario
Caruso, Maria Rosa
Casino, Francesco
Cuzziol, Carlo
Farcomeni, Alessio
Filippini, Armando
Lomonte, Carlo
Marinelli, Rocco
Rolla, Davide
Rubino, Filomena
Seminara, Giuseppe
Pasquali, Marzia
Mazzaferro, Sandro
author_sort Tartaglione, Lida
collection PubMed
description BACKGROUND: Severe secondary hyperparathyroidism (SHPT) is associated with mortality in end stage kidney disease (ESKD). Parathyroidectomy (PTX) becomes necessary when medical therapy fails, thus highlighting the interest to compare biochemical and clinical outcomes of patients receiving either medical treatment or surgery. METHODS: We aimed to compare overall survival and biochemical control of hemodialysis patients with severe hyperparathyroidism, treated by surgery or medical therapy followed-up for 36 months. Inclusion criteria were age older than 18 years, renal failure requiring dialysis treatment (hemodialysis or peritoneal dialysis) and ability to sign the consent form. A control group of 418 patients treated in the same centers, who did not undergo parathyroidectomy was selected after matching for age, sex, and dialysis vintage. RESULTS: From 82 Dialysis units in Italy, we prospectively collected data of 257 prevalent patients who underwent parathyroidectomy (age 58.2 ± 12.8 years; M/F: 44%/56%, dialysis vintage: 15.5 ± 8.4 years) and of 418 control patients who did not undergo parathyroidectomy (age 60.3 ± 14.4 years; M/F 44%/56%; dialysis vintage 11.2 ± 7.6 y). The survival rate was higher in the group that underwent parathyroidectomy (Kaplan–Meier log rank test = 0.002). Univariable analysis (HR 0.556, CI: 0.387–0.800, p = 0.002) and multivariable analysis (HR 0.671, CI:0.465–0.970, p = 0.034), identified parathyroidectomy as a protective factor of overall survival. The prevalence of patients at KDOQI targets for PTH was lower in patients who underwent parathyroidectomy compared to controls (PTX vs non-PTX: PTH < 150 pg/ml: 59% vs 21%, p = 0.001; PTH at target: 18% vs 37% p = 0.001; PTH > 300 pg/ml 23% vs 42% p = 0.001). The control group received more intensive medical treatment with higher prevalence of vitamin D (65% vs 41%, p = 0.0001), calcimimetics (34% vs 14%, p = 0.0001) and phosphate binders (77% vs 66%, p = 0.002). CONCLUSIONS: Our data suggest that parathyroidectomy is associated with survival rate at 36 months, independently of biochemical control. Lower exposure to high PTH levels could represent an advantage in the long term. GRAPHICAL ABSTRACT: [Image: see text] SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40620-023-01658-0.
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spelling pubmed-105435272023-10-03 Parathyroidectomy and survival in a cohort of Italian dialysis patients: results of a multicenter, observational, prospective study Tartaglione, Lida Rotondi, Silverio Aucella, Filippo Bonomini, Mario Caruso, Maria Rosa Casino, Francesco Cuzziol, Carlo Farcomeni, Alessio Filippini, Armando Lomonte, Carlo Marinelli, Rocco Rolla, Davide Rubino, Filomena Seminara, Giuseppe Pasquali, Marzia Mazzaferro, Sandro J Nephrol Original Article BACKGROUND: Severe secondary hyperparathyroidism (SHPT) is associated with mortality in end stage kidney disease (ESKD). Parathyroidectomy (PTX) becomes necessary when medical therapy fails, thus highlighting the interest to compare biochemical and clinical outcomes of patients receiving either medical treatment or surgery. METHODS: We aimed to compare overall survival and biochemical control of hemodialysis patients with severe hyperparathyroidism, treated by surgery or medical therapy followed-up for 36 months. Inclusion criteria were age older than 18 years, renal failure requiring dialysis treatment (hemodialysis or peritoneal dialysis) and ability to sign the consent form. A control group of 418 patients treated in the same centers, who did not undergo parathyroidectomy was selected after matching for age, sex, and dialysis vintage. RESULTS: From 82 Dialysis units in Italy, we prospectively collected data of 257 prevalent patients who underwent parathyroidectomy (age 58.2 ± 12.8 years; M/F: 44%/56%, dialysis vintage: 15.5 ± 8.4 years) and of 418 control patients who did not undergo parathyroidectomy (age 60.3 ± 14.4 years; M/F 44%/56%; dialysis vintage 11.2 ± 7.6 y). The survival rate was higher in the group that underwent parathyroidectomy (Kaplan–Meier log rank test = 0.002). Univariable analysis (HR 0.556, CI: 0.387–0.800, p = 0.002) and multivariable analysis (HR 0.671, CI:0.465–0.970, p = 0.034), identified parathyroidectomy as a protective factor of overall survival. The prevalence of patients at KDOQI targets for PTH was lower in patients who underwent parathyroidectomy compared to controls (PTX vs non-PTX: PTH < 150 pg/ml: 59% vs 21%, p = 0.001; PTH at target: 18% vs 37% p = 0.001; PTH > 300 pg/ml 23% vs 42% p = 0.001). The control group received more intensive medical treatment with higher prevalence of vitamin D (65% vs 41%, p = 0.0001), calcimimetics (34% vs 14%, p = 0.0001) and phosphate binders (77% vs 66%, p = 0.002). CONCLUSIONS: Our data suggest that parathyroidectomy is associated with survival rate at 36 months, independently of biochemical control. Lower exposure to high PTH levels could represent an advantage in the long term. GRAPHICAL ABSTRACT: [Image: see text] SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40620-023-01658-0. Springer International Publishing 2023-06-23 2023 /pmc/articles/PMC10543527/ /pubmed/37351832 http://dx.doi.org/10.1007/s40620-023-01658-0 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Original Article
Tartaglione, Lida
Rotondi, Silverio
Aucella, Filippo
Bonomini, Mario
Caruso, Maria Rosa
Casino, Francesco
Cuzziol, Carlo
Farcomeni, Alessio
Filippini, Armando
Lomonte, Carlo
Marinelli, Rocco
Rolla, Davide
Rubino, Filomena
Seminara, Giuseppe
Pasquali, Marzia
Mazzaferro, Sandro
Parathyroidectomy and survival in a cohort of Italian dialysis patients: results of a multicenter, observational, prospective study
title Parathyroidectomy and survival in a cohort of Italian dialysis patients: results of a multicenter, observational, prospective study
title_full Parathyroidectomy and survival in a cohort of Italian dialysis patients: results of a multicenter, observational, prospective study
title_fullStr Parathyroidectomy and survival in a cohort of Italian dialysis patients: results of a multicenter, observational, prospective study
title_full_unstemmed Parathyroidectomy and survival in a cohort of Italian dialysis patients: results of a multicenter, observational, prospective study
title_short Parathyroidectomy and survival in a cohort of Italian dialysis patients: results of a multicenter, observational, prospective study
title_sort parathyroidectomy and survival in a cohort of italian dialysis patients: results of a multicenter, observational, prospective study
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10543527/
https://www.ncbi.nlm.nih.gov/pubmed/37351832
http://dx.doi.org/10.1007/s40620-023-01658-0
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