Yang Taohong, Xue Yang, Ren Jianping, Li XinYu, Xu Wenting, Nie Guangyang, Wang Deguang, Wang Xuerong
Department of Nephrology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
Curr Pharm Des. 2025;31(33):2691-2704. doi: 10.2174/0113816128390373250507062606.
Renal secondary hyperparathyroidism (SHPT) represents a prevalent complication among dialysis patients, significantly impacting long-term prognosis. Parathyroidectomy (PTX) serves as a clinically effective therapeutic option for patients diagnosed with refractory secondary hyperparathyroidism.
This study aims to assess the impact of PTX on cardiovascular events (CVEs) and all-cause mortality in dialysis patients, as well as to analyze the incidence and potential determinants of postoperative cardiovascular events and all-cause mortality.
We collected data on 710 patients with renal secondary hyperparathyroidism who were treated with PTX between February 2011 and April 2019. A total of 633 patients who underwent PTX were finally included and matched with 462 patients who did not undergo PTX on a 1:1 basis according to age and follow-up duration. Ultimately, 179 pairs were successfully matched to investigate the differences in all-cause mortality and CVEs. The Logistic/Cox regression analyses were employed to identify independent factors associated with adverse CVEs and all-cause mortality among patients receiving PTX. Nomogram prediction models were constructed based on independent influencing factors.
Among 633 patients who underwent PTX, 117 (18.5%) died and 192 (30.3%) experienced CVEs during median 5-year follow-up. No significant differences in cardiovascular/death events were observed between matched groups. In patients who underwent PTX, the logistic regression analysis revealed that age and history of diabetes mellitus were independent risk factors for CVEs. The pre-operative use of cinacalcet and/or calcitriol was associated with a reduced risk of CVEs. With respect to preoperative and postoperative calcium levels, the highest tertile was identified as a risk factor when compared with the lowest tertile. Cox regression showed age, diabetes history, and highest preoperative phosphorus tertile negatively correlated with survival, while albumin (ALB) was positively correlated. The predictive nomogram model had an area under the receiver operating characteristic (ROC) curve of 0.649 for CVE prediction. The areas under the ROC curve for predicting 3-, 5-, and 10-year mortality prediction were 0.865, 0.865, and 0.953, respectively.
PTX does not reduce the incidence of cardiovascular events and mortality in patients on maintenance dialysis. In patients who underwent PTX, older age, a history of diabetes mellitus, and higher preoperative calcium/postoperative calcium levels were independent risk factors for adverse CVEs; preoperative use of cinacalcet and/or calcitriol was a protective risk for CVEs. Older age, a history of diabetes mellitus, lower ALB levels, and hyperphosphatemia were independent risk factors for all-cause mortality following PTX. These predictive models may assist in clinical decision-making to some extent.
肾性继发性甲状旁腺功能亢进（SHPT）是透析患者中常见的并发症，对长期预后有显著影响。甲状旁腺切除术（PTX）是诊断为难治性继发性甲状旁腺功能亢进患者的一种临床有效治疗选择。
本研究旨在评估PTX对透析患者心血管事件（CVE）和全因死亡率的影响，并分析术后心血管事件和全因死亡率的发生率及潜在决定因素。
我们收集了2011年2月至2019年4月期间接受PTX治疗的710例肾性继发性甲状旁腺功能亢进患者的数据。最终纳入633例接受PTX的患者，并根据年龄和随访时间与462例未接受PTX的患者进行1:1匹配。最终成功匹配179对，以研究全因死亡率和CVE的差异。采用Logistic/Cox回归分析确定接受PTX患者中与不良CVE和全因死亡率相关的独立因素。基于独立影响因素构建列线图预测模型。
在633例接受PTX的患者中，在中位5年随访期间，117例（18.5%）死亡，192例（30.3%）发生CVE。匹配组之间在心血管/死亡事件方面未观察到显著差异。在接受PTX的患者中，Logistic回归分析显示年龄和糖尿病史是CVE的独立危险因素。术前使用西那卡塞和/或骨化三醇与CVE风险降低相关。关于术前和术后钙水平，与最低三分位数相比，最高三分位数被确定为危险因素。Cox回归显示年龄、糖尿病史和术前最高磷三分位数与生存率呈负相关，而白蛋白（ALB）呈正相关。预测列线图模型用于CVE预测的受试者操作特征（ROC）曲线下面积为0.649。预测3年、5年和10年死亡率的ROC曲线下面积分别为0.865、0.865和0.953。
PTX不会降低维持性透析患者心血管事件的发生率和死亡率。在接受PTX的患者中，年龄较大、有糖尿病史以及术前/术后钙水平较高是不良CVE的独立危险因素；术前使用西那卡塞和/或骨化三醇是CVE的保护性因素。年龄较大、有糖尿病史、ALB水平较低和高磷血症是PTX后全因死亡率的独立危险因素。这些预测模型在一定程度上可能有助于临床决策。
