Post-parathyroidectomy parathyroid hormone levels: the impact on patient survival - a single-centre study in a stage 5 chronic kidney disease population.

BACKGROUND/AIMS: Both severe, uncontrolled and low parathyroid hormone (iPTH) levels are associated with adverse outcomes in stage 5 chronic kidney disease (CKD) patients; however, the impact of iPTH levels following parathyroidectomy (PTX) is unexplored.

METHODS: A total of 235 stage 5 CKD patients who underwent PTX between 1990 and 2007 were identified, and iPTH levels following surgery were used to divide patients according to the quartile of maximum iPTH recovery during the 5 years following PTX. Survival, biochemistry and pharmacotherapy were analysed.

RESULTS: The maximum iPTH level in each quartile during the follow-up period was <46, 47-139, 140-420 and >420 pg/ml. The overall 5-year survival for the group was 81%. Adjusting for age, time on renal replacement therapy and the presence of diabetes identified an increased hazard for mortality of 2.459 in the quartile of lowest iPTH recovery (p = 0.035). The median 1-alfacalcidol dose during the follow-up period was higher (0.5 μg/day) in the lower iPTH group compared to the 3 quartiles of higher iPTH recovery (0.25 μg/day).

CONCLUSION: An association between the lowest quartile of iPTH recovery in the 5 years following PTX and poorer patient survival was found. This finding should be tested in larger datasets.