Improvement of anemia after parathyroidectomy in chinese patients with renal failure undergoing long-term dialysis

Hypothesis: Most patients undergoing long-term dialysis are anemic because of underproduction of erythropoietin and its inhibition by high parathyroid hormone levels due to secondary hyperparathyroidism. Renal anemia can be improved by parathyroidectomy. Design Retrospective cohort study. Setting Regional hospital. Patients Twenty-three Chinese patients without a previous functioning renal transplant underwent parathyroidectomy for severe secondary hyperparathyroidism in a 3-year period. Intervention Total parathyroidectomy with or without parathyroid autograft at the forearm. Main Outcome Measures The preoperative and 6-month postoperative hematological and biochemical variables were compared for any differences by means of a paired t test. Results: The mean \ub1 SD follow-up duration was 17.7 \ub1 8.1 (range, 6-34) months. Three patients (13%) developed persistent or recurrent hyperparathyroidism and 2 patients (9%) were biochemically hypoparathyroid. The other 18 patients (78%) were euparathyroid. Surgical morbidity was minimal; only 1 patient had complications, consisting of a postoperative fever of unknown origin that resolved with conservative treatment. The mean \ub1 SD hemoglobin level (8.6 \ub1 2.1 vs 9.4 \ub1 2.1 g/dL) but not the mean platelet level was significantly (P =3D .04) increased 6 months postoperatively. Likewise, the following other mean \ub1 SD biochemical values improved after surgery: parathyroid hormone (2235 \ub1 500 vs 151 \ub1 312 pg/mL; P<.001), alkaline phosphatase (645 \ub1 349 vs 123 \ub1 82 U/L; P<.001), calcium (10.8 \ub1 4.0 vs 9.3 \ub1 1.0 mg/dL; P<.001), phosphate (1.93 \ub1 0.73 vs 1.50 \ub1 0.51 mmol/L; P =3D .02), and albumin (3.5 \ub1 0.5 vs 3.8 \ub1 0.6 g/dL; P =3D .006). Conclusions: Parathyroidectomy is highly effective to control secondary hyperparathyroidism with an exceedingly low complication rate. The hemoglobin level was significantly elevated 6 months postoperatively. The long-term effect warrants future trials