Parathyroidectomy reduces intradialytic hypotension in hemodialysis patients with secondary hyperparathyroidism.

Abstract

BACKGROUND:

Secondary hyperparathyroidism is associated with vascular calcification and arterial stiffness in patients with end-stage renal disease. The aim of this study was to analyze the frequency of intradialytic hypotension (IDH) and cardiovascular function before and after parathyroidectomy (PTX) in maintenance hemodialysis patients.

METHODS:

We compared predialytic and intradialytic blood pressure, left and right ventricular ejection fraction (LVEF and RVEF), and cardiothoracic ratio 1 month before PTX, and 6 and 12 months after PTX. IDH was defined as a decrease in systolic blood pressure ≥ 20 mmHg or a decrease in mean arterial pressure ≥ 10 mmHg.

RESULTS:

At the time of PTX, the mean age of the patients was 57.4 ± 12.0 years, and the mean dialysis vintage was 12.2 ± 5.8 years. At baseline, 6 months, and 12 months after PTX, the average numbers of sessions disturbed by IDH during 13 dialysis sessions (1 month) were 6.4, 3.9 (p < 0.016 vs. baseline), and 4.0 sessions (p < 0.037 vs. baseline, p = 0.801 vs. 6 months), respectively. LVEF and RVEF were improved significantly after PTX. Furthermore, volume status was also improved, as evidenced by the significantly greater ultrafiltration volume and reduced cardiothoracic ratio.

CONCLUSIONS:

Hemodialysis patients with severe secondary hyperparathyroidism are more likely to achieve normotensive and euvolemic status after PTX, probably through improved heart function and reduced IDH episodes.

• Authors: Chia-Jen Shih, Der-Cherng Tarng, Wu-Chang Yang, Chih-Yu Yang
• Journal: Kidney & blood pressure research (Kidney Blood Press Res) Vol. 37 Issue 4-5 Pg. 323-31 ( 2013) ISSN: 1423-0143 [Electronic] Switzerland
• PMID: 24080642 (Publication Type: Journal Article, Observational Study)
• Copyright: © 2013 S. Karger AG, Basel.

Topics

• Aged
• Blood Pressure (physiology)
• Female
• Humans
• Hyperparathyroidism, Secondary (diagnosis, epidemiology, physiopathology)
• Hypotension (epidemiology, physiopathology, surgery)
• Kidney Failure, Chronic (epidemiology, physiopathology, therapy)
• Male
• Middle Aged
• Parathyroidectomy (methods)
• Renal Dialysis (adverse effects)