Clinical characteristics and postoperative recurrence of parathyroidectomy patients with different dialysis modalities

Objective To compare the clinical characteristics and postoperative recurrence of parathyroidectomy(PTX) of hemodialysis(HD) versus peritoneal dialysis(PD) patients with secondary hyperparathyroidism(SHPT). Methods From April 2014 to May 2019, SHPT patients initially undergoing PTX were reviewed retrospectively. They were divided into two groups of HD(n=54) and PD(n=45) according to pre-PTX dialysis modality. Preoperative clinical data, pathological types, laboratory tests and recurrence of SHPT after PTX were compared. Results Compared with PD counterparts, HD patients had a longer dialysis duration and higher levels of blood pressure, serum alkaline phosphatase, serum intact parathyroid hormone(iPTH) and mitral valve calcification rate(P<0.05). The distribution of postoperative pathological types was similar between two groups(P>0.05). At the same timepoint after PTX, no significant inter-group differences existed in serum levels of iPTH, calcium or phosphorus(P>0.05). Kaplan-Meier survival curve analysis revealed no inter-group statistical difference in cumulative non-recurrence rate(P>0.05). Multivariate Cox regression analysis indicated that minimal postoperative iPTH >3 ng/L was an independent risk factor for SHPT recurrence (OR=2.260, P=0.019). Receiver operating characteristic (ROC) curve revealed that postoperative iPTH >3.25 ng/L after 1 week, iPTH>18.45 ng/L after 1 month and iPTH >90.75 ng/L after 3 months could be utilized for predicting SHPT recurrence after PTX. Conclusion No significant difference of parathyroid pathological types, postoperative iPTH, calcium and phosphorus metabolism, and SHPT recurrence existed between HD and PD patients. Minimal postoperative iPTH >3 ng/L is an independent risk factor for SHPT recurrence in patients after PTX and postoperative iPTH level is a more reliable predictor of SHPT recurrence.