Secondary hyperparathyroidism (SHP) negatively affects survival of patients with ESRD on D. Achieving even once KDOQI targets for Ca, P and PTH associates with lower risk of mortality. PTX, possibly by improving biochemical control, may improve survival. Aim of this study was to evaluate the impact of PTX on biochemical control and survival of Italian HD patients in the medium term.
We collected data from 149 HD units throughout the Country, by means of a data sheet filled by a reference physician. We recorded 524 living PTX cases (age: 57.90±12.52 y.o; D time: 14.57±8.37 y; sex: 231M/296F), out of a total 12515 receiving D (=4,2%). Time from surgery was 6,0 y (3,0-9,0; M, IQR). A control group was identified (432 cases, 58.9±16.5 y.o.; on D since 11.7±2.6 y; 192M/240F). Follow-up data were requested on a yearly basis for 3 consecutive years.
Compared to the control group, PTX patients had lower Ca (8.76±0.87 vs 9.05±0.73 mg/dl; p <.05), P mg/dl (4.90±1.36 vs 5.10±1.34 mg/dl; p<.05) and PTH (181.9±292.5 vs 333.7±293.7 pg/ml; p<.01), at enrollment. The percentage of patients at target was lower in the PTX group: P = 55,3% vs 58,8 (p<.05); Ca = 50,9% vs 57,6 (p<.001); PTH =17% vs 35% (p<.001). During 1 and 2 years of follow-up, PTH, but not Ca and P, was confirmed to be less frequently at target in the PTX group (21% vs 35%, p<.05). In multivariate adjusted analysis, subdistributional-HR for all-cause mortality was 0,843 (CI 0,783-0,908; p<.0001) for PTX patients.
In conclusion, in D patients PTX associates with lower risk of mortality regardless of achievement of Ca, P or PTH targets.
