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Improvement of Anemia After Parathyroidectomy in Chinese Patients With Renal Failure Undergoing Long-term Dialysis
Tam-Lin Chow, FRCS(Edin);
Tony Tung-Fei Chan, FRCS(Edin);
Yiu-Wing Ho, FRCP;
Siu-Ho Lam, FRCS(Glasg)
Arch Surg. 2007;142(7):644-648.
Hypothesis Most patients undergoing long-term dialysis are anemic because of underproduction of erythropoietin and its inhibition by high parathyroid hormone levels due to secondary hyperparathyroidism. Renal anemia can be improved by parathyroidectomy.
Design Retrospective cohort study.
Setting Regional hospital.
Patients Twenty-three Chinese patients without a previous functioning renal transplant underwent parathyroidectomy for severe secondary hyperparathyroidism in a 3-year period.
Intervention Total parathyroidectomy with or without parathyroid autograft at the forearm.
Main Outcome Measures The preoperative and 6-month postoperative hematological and biochemical variables were compared for any differences by means of a paired t test.
Results The mean ± SD follow-up duration was 17.7 ± 8.1 (range, 6-34) months. Three patients (13%) developed persistent or recurrent hyperparathyroidism and 2 patients (9%) were biochemically hypoparathyroid. The other 18 patients (78%) were euparathyroid. Surgical morbidity was minimal; only 1 patient had complications, consisting of a postoperative fever of unknown origin that resolved with conservative treatment. The mean ± SD hemoglobin level (8.6 ± 2.1 vs 9.4 ± 2.1 g/dL) but not the mean platelet level was significantly (P = .04) increased 6 months postoperatively. Likewise, the following other mean ± SD biochemical values improved after surgery: parathyroid hormone (2235 ± 500 vs 151 ± 312 pg/mL; P<.001), alkaline phosphatase (645 ± 349 vs 123 ± 82 U/L; P<.001), calcium (10.8 ± 4.0 vs 9.3 ± 1.0 mg/dL; P<.001), phosphate (1.93 ± 0.73 vs 1.50 ± 0.51 mmol/L; P = .02), and albumin (3.5 ± 0.5 vs 3.8 ± 0.6 g/dL; P = .006).
Conclusions Parathyroidectomy is highly effective to control secondary hyperparathyroidism with an exceedingly low complication rate. The hemoglobin level was significantly elevated 6 months postoperatively. The long-term effect warrants future trials.
Author Affiliations: Division of Head and Neck, Reconstructive, and Breast Surgery, Department of Surgery (Drs Chow, Chan, and Lam), and Division of Nephrology, Department of Medicine (Dr Ho), United Christian Hospital, Hong Kong.
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Parathyroidectomy and Improving Anemia
Jemcov et al.
Arch Surg 2008;143:97-98.
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