Improvement of anemia after parathyroidectomy in Chinese patients with renal failure undergoing long-term dialysis.

@article{citeulike:2938556, abstract = {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.}, address = {Division of Head and Neck, Reconstructive and Breast Surgery, Department of Surgery, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong.}, author = {Chow, T. L. and Chan, T. T. and Ho, Y. W. and Lam, S. H. }, citeulike-article-id = {2938556}, doi = {http://dx.doi.org/10.1001/archsurg.142.7.644}, issn = {0004-0010}, journal = {Archives of surgery (Chicago, Ill. : 1960)}, keywords = {anemia, china, hd, ptx}, month = {July}, number = {7}, pages = {644--648}, posted-at = {2008-06-28 05:18:28}, priority = {2}, title = {Improvement of anemia after parathyroidectomy in Chinese patients with renal failure undergoing long-term dialysis.}, url = {http://dx.doi.org/10.1001/archsurg.142.7.644}, volume = {142}, year = {2007} }

TY - JOUR ID - citeulike:2938556 L3 - citeulike-article-id:2938556 TI - Improvement of anemia after parathyroidectomy in Chinese patients with renal failure undergoing long-term dialysis. JF - Archives of surgery (Chicago, Ill. : 1960) VL - 142 IS - 7 SP - 644 EP - 648 AD - Division of Head and Neck, Reconstructive and Breast Surgery, Department of Surgery, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong. SN - 0004-0010 N2 - 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. KW - anemia KW - china KW - hd KW - ptx AU - Chow, TL AU - Chan, TT AU - Ho, YW AU - Lam, SH PY - 2007/07// UR - http://dx.doi.org/10.1001/archsurg.142.7.644 ER -