Abstract

The aim of the study is to elucidate whether parathyroid hormone (PTH) levels after parathyroidectomy affect the prognosis of patients with secondary hyperparathyroidism. Two hundred and ninety-five patients, who underwent PTx without autotransplantation from July 1998 to December 2011, were divided into the low (n=148) and high (n=147) PTH groups, using the median value of each mean value of intact PTH after surgery (16.6pg/mL). After observation for 5.00years, we evaluated demographic factors, influences of postoperative mineral metabolism, magnitude of uremia, and vitamin D receptor activators on their prognosis, with the multivariate Cox proportional hazard model. While overall survival rates in the high and low PTH groups were 54.9 and 74.2%, respectively (P=0.1500), cardiovascular survival rates were 71.6 and 94.4%, respectively (P=0.0256). The hazard ratio for cardiovascular mortality in the high PTH group (≥16.6pg/mL) was 3.132 (P=0.0470), and those in groups with the median age more than 59years and with cardiovascular disease were 2.654 (P=0.0589) and 3.377 (P=0.0317), respectively. The intact PTH level 6days after surgery and the mean postoperative intact PTH value showed a strong correlation (Spearman ρ=0.9007, P<0.0001, y=0.4725x+30.395, R 2=0.51798). The present study suggests that maintaining low PTH levels after parathyroidectomy reduces cardiovascular mortality and improves the prognosis. Total parathyroidectomy (more than 4 glands) without autotransplantation seems to be one of the treatment options for managing severe secondary hyperparathyroidism.

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