Disthabanchong Sinee, Saeseow Sarunya, Khunapornphairote Sirote, Suvikapakornkul Ronnarat, Wasutit Yodying, Tungkeeratichai Jumroon
Division of Nephrology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Front Med (Lausanne). 2023 Jul 6;10:1132566. doi: 10.3389/fmed.2023.1132566. eCollection 2023.
AIMS/INTRODUCTION: Parathyroidectomy is associated with improved survival in patients with end-stage kidney disease. Protein-energy wasting (PEW) is common in patients with kidney failure and predicts poor outcomes. Recent clinical trials have linked hyperparathyroidism to PEW. The present retrospective cohort study examined whether parathyroidectomy was associated with improvement in nutritional status in maintenance hemodialysis patients.
One hundred twenty-nine maintenance hemodialysis patients who had successful parathyroidectomy during 2012-2018 were identified (PTX group) and matched 1:1 to 479 patients with parathyroid hormone (PTH) levels ≤1,000 pg./mL (non-PTX control group) and 187 patients with PTH levels >1,000 pg./mL (pre-PTX control group) by propensity score. The matchings yielded 120 matched pairs from PTX and non-PTX groups (cohort 1) and 76 matched pairs from PTX and pre-PTX groups (cohort 2). Baseline and follow-up nutritional parameters associated with PEW were compared over the 12-month study period.
In cohort 1, substantially lower serum albumin and serum creatinine/body surface area (Cr/BSA) and higher proportions of patients with serum albumin ≤38 g/L (low albumin) and serum Cr/BSA ≤380 μmol/L/m (low Cr/BSA) were observed in the PTX group. These parameters improved significantly after parathyroidectomy. Total lymphocyte count (TLC) was comparable at baseline but the percentage of patients with TLC <800 cells/mm (low TLC) decreased substantially after parathyroidectomy. At follow-up, serum albumin, serum Cr/BSA and proportions of patients with low albumin and Cr/BSA became comparable with the non-PTX control group. The percentage of patients with low TLC became lower in the PTX group. Mixed-models analysis confirmed significant differences in the changes in serum albumin, serum Cr/BSA, and proportions of patients with low albumin and TLC between the two groups. In cohort 2, nutritional parameters were comparable at baseline. At follow-up, serum Cr/BSA was higher and proportions of patients with body mass index ≤18.5 kg/m, low TLC and low Cr/BSA were lower in the PTX group. Weight gain was more frequent and of greater magnitude in the PTX group in both cohorts. A substantial reduction in blood pressure was also observed in the PTX group.
Severe hyperparathyroidism was associated with nutritional impairment which improved considerably after parathyroidectomy.
目的/引言：甲状旁腺切除术与终末期肾病患者生存率提高相关。蛋白质能量消耗（PEW）在肾衰竭患者中很常见，并预示不良预后。近期临床试验已将甲状旁腺功能亢进与PEW联系起来。本回顾性队列研究探讨了甲状旁腺切除术是否与维持性血液透析患者营养状况改善相关。
确定了2012年至2018年期间成功进行甲状旁腺切除术的129例维持性血液透析患者（PTX组），并通过倾向评分将其与479例甲状旁腺激素（PTH）水平≤1000 pg/mL的患者（非PTX对照组）以及187例PTH水平>1000 pg/mL的患者（术前PTX对照组）按1:1进行匹配。匹配后，PTX组和非PTX组产生了120对匹配对（队列1），PTX组和术前PTX组产生了76对匹配对（队列2）。在12个月的研究期间比较了与PEW相关的基线和随访营养参数。
在队列1中，PTX组观察到血清白蛋白和血清肌酐/体表面积（Cr/BSA）显著降低，血清白蛋白≤38 g/L（低白蛋白）和血清Cr/BSA≤380 μmol/L/m（低Cr/BSA）的患者比例更高。甲状旁腺切除术后这些参数显著改善。总淋巴细胞计数（TLC）在基线时相当，但甲状旁腺切除术后TLC<800细胞/mm（低TLC）的患者比例大幅下降。随访时，血清白蛋白、血清Cr/BSA以及低白蛋白和低Cr/BSA患者的比例与非PTX对照组相当。PTX组低TLC患者的比例更低。混合模型分析证实两组之间血清白蛋白、血清Cr/BSA以及低白蛋白和TLC患者比例的变化存在显著差异。在队列2中，营养参数在基线时相当。随访时，PTX组的血清Cr/BSA更高，体重指数≤18.5 kg/m²、低TLC和低Cr/BSA的患者比例更低。两个队列中PTX组体重增加更频繁且幅度更大。PTX组还观察到血压大幅降低。
严重甲状旁腺功能亢进与营养损害相关，甲状旁腺切除术后营养损害有显著改善。
