The impact of parathyroidectomy on the dynamics of CKD-MBD laboratory parameters and survival of dialysis patients in St.-Petersburg

Aim: To compare impact of parathyroidectomy (PTE) and conservative therapy (CT) on laboratory markers of CKD-MBD and survival in severe refractory secondary hyperparathyroidism. Methods: In a representative cohort of dialysis patients in St. Petersburg we compared the dynamics of average annual values of basic laboratory markers of mineral and bone metabolism and the survival rate between the groups of patients with resistant severe secondary hyperparathyroidism with performed PTE (84), and continued to receive CT (105). Groups were significantly different only in the duration of dialysis therapy and the level of serum calcium. Results: PTE resulted in a statistically significant reduction in level of PTH (1166±527 to 199±207 pg/ml), calcium (2.49±0.20 to 2.18±0.29 mmol/l) and phosphorus (2.46±0.50 to 1.96±0.58 mmol/l) with high frequency of hypocalcemia (44%) and hypoparathyroidism (52%) during the first year after surgery. The fraction of patients with phosphate concentration within target range increased from 4 to 46%. In CT group, a reduction of phosphate level (5%) was the only significant change in a laboratory parameter during the first year. The survival rate in PTE group was significantly higher. There were two significant factors, which determined the survival difference in Cox multivariate model: age (increased risk of death by 2.1% per one year) and PTE (reducing the risk of death by 2.3 times). Conclusions: In current clinical practice parathyroidectomy seems to be preferred method for therapy of resistant severe secondary hyperparathyroidism (PTH levels higher 800 pg/ml for six months) and can significantly reduce the risk of death in this group.

вторичный гиперпаратиреоз, паратиреоидэктомия, выживаемость, secondary hyperparathyroidism, parathyroidectomy, survival

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