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Objective:To compare the survival rate of secondary hyperparathyroidism (SHPT) patients with different dialysis modalities after parathyroidectomy (PTX), and analyze the influencing factors of survival prognosis.Methods:Clinical data of dialysis patients diagnosed with SHPT and treated with PTX in the First People′s Hospital of Foshan from April 2014 to May 2019 were retrospectively collected and analyzed. The patients were divided into hemodialysis (HD) group and peritoneal dialysis (PD) group according to preoperative dialysis modalities, and the differences in baseline clinical data and cardiac ultrasound results were compared between the two groups. Kaplan-Meier survival analysis was used to compare the difference in cumulative survival rate between the two groups. Multivariate Cox regression model was used to analyze the influencing factors of all-cause death. Receiver operating characteristic curve (ROC curve) was used to predict the risk of all-cause death.Results:A total of 99 patients were enrolled in this study, and 94 patients completed follow-up, including 23 patients who died. Compared with PD group ( n=45), HD group ( n=54) had higher dialysis age, blood pressure, intact parathyroid hormone, alkaline phosphatase, total heart valve calcification rate, mitral valve calcification proportion, interventricular septal thickness (IVST) and left ventricular mass index (all P<0.05). The median follow-up time was 46.00(32.75, 60.25) months. Kaplan-Meier survival analysis showed that there was no significant difference in cumulative survival rate between HD group and PD group (Log-rank test χ2=0.414, P=0.520). Multivariate Cox regression analysis showed that increasing age ( HR=1.066, 95% CI 1.017-1.118, P=0.008), systolic blood pressure>140 mmHg ( HR=2.601, 95% CI 1.002-6.752, P=0.049) and increasing IVST ( HR=1.269, 95% CI 1.036-1.554, P=0.021) were independent influencing factors for all-cause death in dialysis patients after PTX. ROC curve analysis results showed that the cut-off values of age, dialysis age and IVST for predicting all-cause death after PTX were 51.5 years old ( AUC=0.673, 95% CI 0.545-0.802, P=0.013) and 75.0 months ( AUC=0.654, 95% CI 0.528-0.780, P=0.027) and 13.5 mm ( AUC=0.680, 95% CI 0.557-0.803, P=0.010) respectively. The area under the ROC curve for age, dialysis age, IVST, left ventricular hypertrophy in combination with systolic blood pressure>140 mmHg in the prediction of all-cause death after PTX was 0.776(95% CI 0.677-0.875, P<0.001). Conclusions:There is no significant difference in cumulative survival rate between HD and PD patients with SHPT after PTX. Increasing age, systolic blood pressure>140 mmHg and increasing IVST are independent risk factors for all-cause death in dialysis patients with SHPT after PTX.
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Objective:To observe the changes of abdominal aortic calcification and biochemical indicators after parathyroidectomy (PTX) in the maintenance hemodialysis (MHD) patients with secondary hyperparathyroidism (SHPT).Methods:The MHD patients with SHPT who were followed up for 2 years were analyzed retrospectively and divided into PTX surgery group ( n=26) and non-surgery group ( n=18) according to whether they underwent PTX, and then the abdominal aortic calcification score (AACS), intact parathyroid hormone (iPTH), blood calcium and phosphorus after 2 years were observed in the two groups. The PTX surgery group was divided into advanced group and non-advanced group according to whether abdominal aortic calcification had progressed or not 2 years after the operation. Indicators such as age, dialysis age, iPTH, blood calcium, blood phosphorus, calcium and phosphorus product were compared between the two groups to analyze the possible factors related to the development of abdominal aortic calcification. Results:A total of 44 patients meeting the inclusion criteria were included, with 26 in the PTX surgery group and 18 in the non-surgery group. The baseline data of the PTX surgery group and the non-surgery group showed statistical difference in the age of dialysis ( P<0.05), but no statistical differences in gender, age and history of hypertension. Compared with preoperative indicators, postoperative iPTH, blood calcium and phosphorus significantly reduced (all P<0.05), and there was no significant difference in AACS. There were 8 cases (30.77%) of accelerating progress of calcification, 8 cases (30.77%) of improvement in calcification, 10 cases (38.46%) of calcification stability. After 2 years, iPTH value of non-advanced group was significantly lower than advanced group [(20.62±6.44) ng/L vs (132.72±76.83) ng/L], while the preoperative AACS progress was higher in non-advanced group [(13.11±2.71) vs (2.00±1.41)] (all P<0.05). In non-surgery group, AACS was significantly higher after 2 years [(10.44±1.65) vs (8.05±1.26)], blood phosphorus and the product of blood calcium and phosphorus significantly decreased (all P<0.05) , and the levels of iPTH and blood calcium did not significantly change. Pearson correlation analysis showed that the decreased value between preoperative AACS and 2-year postoperative AACS was positively correlated with the decreased value of iPTH ( r=0.534, P=0.012), blood calcium ( r=0.643, P=0.004), blood phosphorus ( r=0.897, P<0.001) and calcium-phosphorus product ( r=0.568, P=0.021) , and negatively correlated with preoperative AACS ( r=-0.647, P=0.014). Conclusions:Small sample data shows that PTX can correct parathyroid hormone, calcium and phosphorus for long term, and prevent abdominal aortic calcification progression, even reverse vascular calcification. Whether abdominal aortic calcification improves or not may be associated with the decrease of iPTH, calcium, phosphorus and the product of blood calcium and phosphorus.
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Objective To assess the medium and long term efficacy of hemodialysis combined with hemo-perfusion on the endothelial function in patients with maintance hemodialysis(MHD). Methods 60 stable MHD patients were enrolled in the research and randomly divided into 2 group. The observation group received hemodialy-is combined blood perfusion,and the control group received pure hemodialysis therapy. Blood was collected before and after treatment for 6 months for detection of serum C-reactive protein (CRP),hemoglobin (HB),albumin (ALB),advanced glycation end products(AGEs),homocysteine(Hcy)and intercellular cell adhesion molecule (ICAM). Results Plasma hs-CRP,AGEs,Hcy and ICAM decreased gradually after the treatment for 6 months. Compared with the indexes before treatment ,serum HGB and ALB increased significantly after the treatment for 6 months(P < 0.05). Conclusions Hemodialysis combined with hemoperfusion with an appropriate frequency and in a medium or long period is a safe ,convenient,and effective approach for MHD patients to pretect the endotheli-al function.
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Objective To assess the medium and long term efficacy of hemodialysis combined with hemo-perfusion on the endothelial function in patients with maintance hemodialysis(MHD). Methods 60 stable MHD patients were enrolled in the research and randomly divided into 2 group. The observation group received hemodialy-is combined blood perfusion,and the control group received pure hemodialysis therapy. Blood was collected before and after treatment for 6 months for detection of serum C-reactive protein (CRP),hemoglobin (HB),albumin (ALB),advanced glycation end products(AGEs),homocysteine(Hcy)and intercellular cell adhesion molecule (ICAM). Results Plasma hs-CRP,AGEs,Hcy and ICAM decreased gradually after the treatment for 6 months. Compared with the indexes before treatment ,serum HGB and ALB increased significantly after the treatment for 6 months(P < 0.05). Conclusions Hemodialysis combined with hemoperfusion with an appropriate frequency and in a medium or long period is a safe ,convenient,and effective approach for MHD patients to pretect the endotheli-al function.
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Objective To observe the influence of highflux hemodialysis(HFD)on homocysteine(Hcy) level and major cardiovascular events of maintenance hemodialysis (MHD) patients. Methods Patients eligible for inclusion were randomly divided into HFD group and low flux hemodialysis(HD)group with 30 cases in each group. Patient′s serum homocysteine (Hcy),major cardiovascular events and various clinical indicators were observed for 12 months then the data were analyzed. Results Hcy baseline levels in 2 groups(21.02 ± 11.79 mmol/L vs. 19.86 ± 6.97 mmol/L)indicated no significant difference(P = 0.162)before hemodialysis but Hcy levels had significant difference(20.29 ± 11.45 mmol/L vs. 24.57 ± 13.23 mmol/L),(P=0.045)after 12-month observation. There was lower incidence of major cardiovascular events in HFD when compared to that in HD group (10.0% vs. 33.3%) which showed significantly statistical difference (P=0.034),and there was no mortality in HFD group but 1 case of death in HD group. All-cause mortality in 2 groups showed no significant difference (P > 0.05). Conclusion Long-term HFD treatment significantly reduces Hcy levels and the incidence of major cardiovascular events of MHD patients
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Objective To study the effcts of total parathyroidectomy with autotransplantation (tPTX+AT) on fibroblast growth factor-23 (FGF-23) in maintenance hemodialysis (MHD) patients with severe secondary hyperparathyroidism (SPTH). Methods Maintenance hemodialysis patients with severe SPTH treated in our hospital from 2014 to 2016 were enrolled and divided into two groups:tPTX+AT group and non-surgical group. Two groups' biochemical indexes and FGF-23 level before and after 6 months treatment were compared. Results A total of 48 patients were included in the study, including 22 in the tPTX+AT group and 26 in the non-surgical group. Age, duration of dialysis, primary disease, rate of hypertension, parathyroid hormone (iPTH), FGF - 23, cholesterol (TCH), triglyceride (TG), albumin (ALB), and hemoglobin (HGB) level showed no significant difference between the two groups (P>0.05); but serum calcium and alkaline phosphatase (ALP) of that tPTX+AT group were significantly higher than those of the non-surgical group (P<0.01). After 6 months the blood iPTH, calcium, phosphorus and the calcium-phosphorus product level of tPTX+AT group were significantly lower than those of non-surgical group (P<0.05). Blood lipids, propagated, HGB, and ALP level had no statistical differences in the two groups (P>0.05); serum FGF-23 progressive declined after 1 week, 1 month, 3 month and 6 month in tPTX+AT patients, and after 6 months, the level of FGF-23 was significantly lower than that of non-surgical patients[1462.9(903.7, 5826.9) ng/L vs 12627.9(5488.9, 16844.4) ng/L, P<0.01]. Conclusion tPTX+AT can significantly alleviate calcium and phosphorus metabolism disorders and in 6 months gradually reduce FGF-23 level in patients receiving MHD.