ABSTRACT
Objective To evaluate the effect of total parathyroidectomy and autotransplantation (TPTX+AT) and total parathyroidectomy (TPTX) on secondary hyperparathyroidism (SHPT). Methods PubMed, EMBASE and Cochrane library were searched from inception to June 2017 for relative studies, which were screened according to inclusion criteria. Meta-analysis of included study were conducted to compare the improvement of symptoms, persistent SHPT, recurrent SHPT, reoperation, hypoparathyroidism, duration of operation and hospitalization between TPTX+AT group and TPTX group. Results A total of 11 studies with 1212 patients were included. Results of meta-analyses showed no difference between TPTX+AT and TPTX regarding improvement of symptoms and persistent SHPT (RR=1.03, P=0.70; RR=0.81, P=0.67, respectively), but TPTX was associated with lower risks of recurrent SHPT and reoperation (RR=0.25, P<0.01; RR=0.19, P<0.01). Patients with TPTX had higher rate of hypoparathyroidism (RR=2.68, P<0.01) but shorter time of operation (MD=-17.3, P=0.01). Durations of hospitalization were similar between the two groups (MD=-0.06, P=0.98). Conclusion Compared with TPTX+AT, TPTX reduces the risks of recurrent SHPT, reoperation andoperation time, but has higher risk of hypoparathyroidism.
ABSTRACT
Objective@#To evaluate the effect of total parathyroidectomy and autotransplantation (TPTX+AT) and total parathyroidectomy (TPTX) on secondary hyperparathyroidism (SHPT).@*Methods@#PubMed, EMBASE and Cochrane library were searched from inception to June 2017 for relative studies, which were screened according to inclusion criteria. Meta-analysis of included study were conducted to compare the improvement of symptoms, persistent SHPT, recurrent SHPT, reoperation, hypoparathyroidism, duration of operation and hospitalization between TPTX+AT group and TPTX group.@*Results@#A total of 11 studies with 1212 patients were included. Results of meta-analyses showed no difference between TPTX+AT and TPTX regarding improvement of symptoms and persistent SHPT (RR=1.03, P=0.70; RR=0.81, P=0.67, respectively), but TPTX was associated with lower risks of recurrent SHPT and reoperation (RR=0.25, P<0.01; RR=0.19, P<0.01). Patients with TPTX had higher rate of hypoparathyroidism (RR=2.68, P<0.01) but shorter time of operation (MD=-17.3, P=0.01). Durations of hospitalization were similar between the two groups (MD=-0.06, P=0.98).@*Conclusion@#Compared with TPTX+AT, TPTX reduces the risks of recurrent SHPT, reoperation and operation time, but has higher risk of hypoparathyroidism.
ABSTRACT
Objective To identify the risk factors associated with cardiovascular and cerebrovascular disease (CCVD) in maintenance hemodialysis (MHD) patients. Methods We analyzed all of the patients undergoing maintenance hemodialysis in the dialysis center of the 3rd Affiliated Hospital of Sun Yat-sen University for at least 3 months from Jan 1st, 2009 to Dec 31st, 2014. Baseline and yearly interval clinical data were recorded and patients were followed up until morbidity or death of CCVD. Cox proportional hazard regression and time-dependent Cox regression were used to estimate the relative risk of outcomes associated with clinical measurements. Results There were 243 patients enrolled in the study, with a mean age of (53.2 ± 16.4) years old, and 138 of them were male (56.8%). The multivariate Cox proportional model revealed that age (HR=1.040, 95%CI:1.015-1.065, P=0.002), Erythropoietin (EPO) dose (HR=0.914, 95%CI: 0.846-0.987, P=0.022) and history of cardiovascular and cerebrovascular disease (HR=4.045, 95%CI: 2.074-7.890, P<0.001) were independent predictors of CCVD in MHD patients. After adjusting for baseline predictors, time-dependent serum phosphorus level (HR=1.722, 95%CI: 1.034-2.866, P=0.037) was significantly associated with CCVD. Conclusion Older age, decreases in EPO dose and history of cardiovascular and cerebrovascular disease were associated with increased risks of CCVD in MHD patients. Increase in serum phosphorus level was associated with increased risks of CCVD in a time-dependent manner.