Abstract: SA-PO884

Parathyroidectomy (PTX), KDOQI Targets, PTH Lowering Therapies, and Mortality in a Cohort of Italian Dialysis (D) Patients: A Multicenter Observational Study

Session Information

  • Mineral Disease: CKD-Bone
    November 04, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Mineral Disease

  • 1203 Mineral Disease: CKD-Bone

Author

  • Mazzaferro, Sandro, Sapienza University of Rome, Rome, Italy

Group or Team Name

  • On behalf of Italian Study Group of Mineral Metabolism
Background

PTX might improve survival by improving biochemical control.

Methods

We prospectively collected data of 528 prevalent PTX cases (age: 57.63±12.52 y.o; D time: 14.63±8.37 y; M/F: 44/56%) from 149 D units in Italy, out of 12515 patients on D (=4,2%) and evaluated KDOQI targets, therapies and survival. Control cases (n=418, nested case-control selection) were balanced for sex (45/55%) but not age (60.30±14.36 y.o, p<.01) or D duration (11.2±7.3 y; p<.001).

Results

PTX cases were at lower KDOQI targets for Ca (50 vs 57 %; p<.05) and PTH (19 vs 37%; p<.001) and received more calcitriol and Ca-based phosphate binders and less calcimimetic than controls. Also PTX cases included in the follow-up were less frequently at target for PTH and were confirmed to receive more calcitriol and Ca-based phosphate binders and less calcimimetic than controls (table 1). Univariate analysis adjusted for D age, showed lower HR of mortality for PTX (0.556, CI:0.387-0.800, p=.002), albumin (0.327; CI:0.249-0.555, p=.000) and hemoglobin (0.672, CI:0.558-0.810, p=.000). Multivariate analysis confirmed PTX (HR 0.679, CI:0.465-0.970, p<.05), age (HR 1.043, CI 1.014-1.055, p<.001) and D duration (HR 1.034, CI 1028-1059, p<.001) as independent predictors of mortality. Albumin inclusion in the model excluded PTX (p=0.065). Indeed, PTX cases had higher albumin levels than controls (3.8±0.4 vs 3.6±0.4; p<.01).

Conclusion

PTX associates with lower risk of mortality regardless of PTH control and despite “more risky” therapy. As a toxin, PTH could negatively affects serum albumin.

Table 1

Funding

  • Commercial Support