Malberti Fabio, Marcelli Daniele, Conte Ferruccio, Limido Aurelio, Spotti Donatella, Locatelli Francesco
Registro Lombardo Dialisi e Trapianto, Milano, Italy.
J Am Soc Nephrol. 2001 Jun;12(6):1242-1248. doi: 10.1681/ASN.V1261242.
Secondary hyperparathyroidism is a frequent complication of long-term dialysis treatment, and despite recent advances in medical therapy, surgical parathyroidectomy (PTx) is necessary in a considerable number of uremic patients. A prevalence of PTx of 22% was reported in Europe in 1988 in patients on dialysis from 10 to 15 yr, but no large-scale epidemiologic study has been published since then. The aim of the study was to evaluate the prevalence, incidence, and risk factors for PTx in patients on renal replacement therapy (RRT) in Lombardy and to determine whether the incidence has changed over time. The study involved 14,180 patients included in the Lombardy Registry of Dialysis and Transplantation who received RRT for end-stage renal disease (ESRD) between 1983 and 1996. Cox-proportional hazards regression models were used to evaluate the risk factors of PTx, the explanatory covariates being age on admission to RRT, gender, underlying renal disease (nondiabetic or diabetic nephropathy), and dialysis modality (peritoneal dialysis or hemodialysis). The prevalence of PTx in the 7371 ERSD patients who were alive on December 31, 1996, was 5.5% and increased with the duration of RRT (9.2% after 10 to 15 yr, 20.8% after 16 to 20 yr). Similarly, the incidence of PTx increased from 3.3 per 1000 patient-years in patients who had been on RRT for <5 yr to 30 per 1000 patient-years in those receiving RRT for >10 yr. The Cox regression models showed that the relative risk for PTx was significantly higher in women and lower in elderly and diabetic patients. The relative risk for PTx (adjusted for gender, age, and nephropathy) was higher in the patients on peritoneal dialysis than in those on hemodialysis and decreased after transplantation. During the course of a follow-up of 7 yr, the incidence of PTx in patients who started RRT between 1990 and 1992 was no different from that observed in patients who started RRT between 1983 and 1985. In conclusion, the prevalence and incidence of PTx in patients receiving RRT in Lombardy is lower than that in Europe and Italy as a whole, as reported by the 1988 European Dialysis and Transplantation Association Registry; its frequency has not changed significantly during the past few years. The need for PTx decreases markedly after successful transplantation. The epidemiologic finding that the rate of PTx is greater in women, young patients, and individuals who do not have diabetes suggests the need for a more aggressive medical treatment of secondary hyperparathyroidism particularly in such patients.
继发性甲状旁腺功能亢进是长期透析治疗的常见并发症，尽管近年来药物治疗取得了进展，但相当一部分尿毒症患者仍需要进行甲状旁腺切除术（PTx）。1988年欧洲报道，透析10至15年的患者中PTx的患病率为22%，但自那时以来尚未发表大规模的流行病学研究。本研究的目的是评估伦巴第地区接受肾脏替代治疗（RRT）患者PTx的患病率、发病率和危险因素，并确定发病率是否随时间变化。该研究纳入了1983年至1996年间在伦巴第透析和移植登记处登记的14180例因终末期肾病（ESRD）接受RRT的患者。采用Cox比例风险回归模型评估PTx的危险因素，解释性协变量为开始RRT时的年龄、性别、潜在肾病（非糖尿病或糖尿病肾病）和透析方式（腹膜透析或血液透析）。1996年12月31日仍存活的7371例ESRD患者中PTx的患病率为5.5%，并随RRT持续时间增加（10至15年后为9.2%，16至20年后为20.8%）。同样，PTx的发病率从RRT时间<5年的患者每1000患者年3.3例增加到RRT时间>10年的患者每1000患者年30例。Cox回归模型显示，女性PTx的相对风险显著更高，而老年和糖尿病患者则较低。PTx的相对风险（根据性别、年龄和肾病调整）在腹膜透析患者中高于血液透析患者，移植后降低。在7年的随访过程中，1990年至1992年开始RRT的患者中PTx的发病率与1983年至1985年开始RRT的患者中观察到的发病率没有差异。总之，伦巴第地区接受RRT患者的PTx患病率和发病率低于1988年欧洲透析和移植协会登记处报告的欧洲和意大利整体水平；在过去几年中其发生率没有显著变化。成功移植后PTx的需求显著降低。PTx发生率在女性、年轻患者和非糖尿病患者中更高这一流行病学发现表明，对于继发性甲状旁腺功能亢进需要更积极的药物治疗，尤其是在这类患者中。
