#4958 IMPROVEMENT OF NUTRITIONAL STATUS AFTER PARATHYROIDECTOMY IN PATIENTS RECEIVING MAINTENANCE HEMODIALYSIS

Abstract

Abstract Background and Aims Improvement in quality of life and survival have been reported after parathyroidectomy in patients with end-stage kidney disease. In addition to bone loss, protein-energy wasting has also been linked to excess parathyroid hormone (PTH) level. The present study examined the changes of nutritional parameters after parathyroidectomy in patients receiving maintenance hemodialysis compared non-parathyroidectomized patients. Method One hundred eighty-seven hemodialysis patients who underwent parathyroidectomy during 2012–2018 were identified (PTX group) and matched 1:1 to 479 patients with parathyroid hormone (PTH) levels ≤1000 pg/mL (non-PTX control group) and 187 patients with PTH levels >1000 pg/mL (pre-PTX control group) by propensity score. The matchings yielded 120 matched pairs from PTX and non-PTX groups (cohort 1) and 76 matched pairs from PTX and pre-PTX groups (cohort 2). Baseline and follow-up nutritional data were compared over the 12-month study period. Results In cohort 1, substantially lower serum albumin and creatinine/body surface area (Cr/BSA) and higher proportions of patients with serum albumin ≤38 g/L (low serum albumin) and Cr/BSA ≤380 μmol/L/m2 (low serum Cr/BSA) were observed in the PTX group. These parameters and the percentage of patients with total lymphocyte count <800 cells/mm3 (low TLC) improved substantially after parathyroidectomy. At follow-up, serum albumin, Cr/BSA and proportions of patients with low serum albumin and Cr/BSA became comparable to the non-PTX control group. The percentage of patients with low TLC was also lower at follow-up in the PTX group. Mixed-models analysis confirmed significant differences in the changes of serum albumin, Cr/BSA, proportions of patients with low serum albumin and TLC between the two groups. In cohort 2, there was no significant difference in baseline nutritional parameters. At follow-up, serum Cr/BSA was higher and proportions of patients with body mass index (BMI) ≤18.5 kg/m2, low TLC and low Cr/BSA were lower in the PTX group. Weight gain was more frequent and of greater magnitude in the PTX group in both cohorts. Higher baseline PTH level, parathyroidectomy and lower baseline serum albumin and creatinine were significantly associated with ≥10% increase in the BMI. Conclusion Parathyroidectomy was associated with nutritional improvement in maintenance hemodialysis patients with severe hyperparathyroidism.