Original ArticlesESRD and Chronic Dialysis

Clinical Outcomes after Parathyroidectomy in a Nationwide Cohort of Patients on Hemodialysis

Areef Ishani, Jiannong Liu, James B. Wetmore, Kimberly A. Lowe, Thy Do, Brian D. Bradbury, Geoffrey A. Block and Allan J. Collins
CJASN January 2015, 10 (1) 90-97; DOI: https://doi.org/10.2215/CJN.03520414

Article Figures & Data

Figures

  • Figure 1.
    Figure 1.

    Patient flow chart.

  • Figure 2.
    Figure 2.

    Event rates in the 1 year before and 1 year after parathyroidectomy. (A) Total hospitalizations. (B) Total hospitalizations with hypocalcemia. (C) Total emergency department or observation visits. (D) Total emergency department or observation visits with hypocalcemia. RR and 95% CI values are based on the ratio of postparathyroidectomy to prior parathyroidectomy. 95% CI, 95% confidence interval; ED, emergency department; PTx, parathyroidectomy; RR, rate ratio.

  • Figure 3.
    Figure 3.

    Outcomes by select patient characteristics. Data points in gray represent subgroups in which a significant interaction (P<0.05) exists between the subgroup and parathyroidectomy. Data points in black have a nonsignificant P for interaction (P>0.05). ASHD, atherosclerotic heart disease; BMI, body mass index; CHF, congestive heart failure; CVA/TIA, cerebrovascular accident/transient ischemic attack; ICU, intensive care unit; PVD, peripheral vascular disease.

Tables

  • Table 1.

    Baseline characteristics of parathyroidectomy patients

    CharacteristicAll Patients, n (%)
    Total4435 (100.0)
    Age (yr)
     19–441764 (39.8)
     45–642154 (48.6)
     65–74410 (9.2)
     ≥75107 (2.4)
    Race
     White1685 (38.0)
     Black2551 (57.5)
     Other199 (4.5)
    Sex
     Men2298 (51.8)
     Women2137 (48.2)
    Primary cause of ESRD
     Diabetes1013 (22.8)
     Hypertension1462 (33.0)
     Glomerulonephritis934 (21.1)
     Other/unknown/missing1026 (23.1)
    BMI (kg/m2)
     <18151 (3.4)
     18 to <251217 (27.4)
     25 to <301026 (23.1)
     30 to <35772 (17.4)
     35 to <40517 (11.7)
     ≥40536 (12.1)
     Missing216 (4.9)
    Dialysis duration (yr)
     1 to < 3538 (12.1)
     3 to < 5970 (21.9)
     ≥52927 (66.0)
    Comorbid conditions (%)a
     Congestive heart failure1973 (44.5)
     CVA/TIA522 (11.8)
     ASHD1542 (34.8)
     Peripheral vascular disease1389 (31.3)
     Dysrhythmia1057 (23.8)
     Cardiac disease, other1623 (36.6)
     Diabetes1954 (44.1)

    • BMI, body mass index; CVA/TIA; cerebrovascular accident/transient ischemic attack; ASHD, atherosclerotic heart disease.

    • ↵a Comorbid conditions were identified from the Medical Evidence Report and medical claims during 12-month period before parathyroidectomy.

  • Table 2.

    Events before and after parathyroidectomy

    OutcomeBefore Parathyroidectomy (n=4435)After Parathyroidectomy (n=4435)Rate Ratio
    Patients with Event, nEvents, nPercent (95% CI)Rate per 100 Patient-Years (95% CI)Patients with Event, nEvents, nMedian Follow-Up, yrPercent (95% CI)Rate per 100 Patient-Years (95% CI)After versus Before (95% CI)
    30-Day outcomes
     Hospitalization105712510.0823.8 (22.6 to 25.1)344.4 (325.2 to 363.6)
     ICU stay3673670.088.3 (7.5 to 9.1)105.8 (93.6 to 115.2)
     Hospital days105762590.0823.8 (22.6 to 25.1)1724.4 (1681 to 1768)
    1-Year outcomes
     Hospitalization2477614755.9 (54.4 to 57.3)138.6 (135.1 to 142.1)283275711.063.9 (62.4 to 65.3)192.0 (187.7 to 196.3)1.39 (1.34 to 1.44)
     ICU stay required997168022.5 (21.3 to 23.7)37.9 (36.1 to 39.7)141525241.031.9 (30.5 to 33.3)64.0 (61.5 to 66.5)1.69 (1.59 to 1.80)
     Total hospital days247735,004789.3 (781.0 to 797.5)283249,0961.01245.0 (1234 to 1256)1.58 (1.56 to 1.60)
    Cause-specific hospitalization
     CHF3915688.8 (8.0 to 9.7)12.8 (11.8 to 13.9)3074531.06.9 (6.2 to 7.7)11.5 (10.4 to 12.5)0.90 (0.80 to 1.02)
     CVA/TIA67761.5 (1.2 to 1.9)1.7 (1.3 to 2.1)1011241.02.3 (1.8 to 2.7)3.1 (2.6 to 3.7)1.83 (1.38 to 2.43)
     Dysrhythmia1141502.6 (2.1 to 3.0)3.4 (2.8 to 3.9)1541921.03.5 (2.9 to 4.0)4.9 (4.2 to 5.6)1.44 (1.16 to 1.78)
     AMI1021302.3 (1.9 to 2.7)2.9 (2.4 to 3.4)1742291.03.9 (3.4 to 4.5)5.8 (5.1 to 6.6)1.98 (1.60 to 2.46)
     With hypocalcemia83981.9 (1.5 to 2.3)2.2 (1.8 to 2.6)94214861.021.2 (20.0 to 22.4)37.7 (35.8 to 39.6)17.05 (13.90 to 20.92)
    Total outpatient visits
     Total ED/observation330913,94174.6 (73.3 to 75.9)314.3 (309.1 to 319.6)340814,9161.076.8 (75.6 to 78.1)378.3 (372.2 to 384.3)1.20 (1.17 to 1.23)
     ED/observation with hypocalcemia841061.9 (1.5 to 2.3)2.4 (1.9 to 2.8)107219261.024.2 (22.8 to 25.4)48.8 (46.7 to 51.0)20.44 (16.81 to 24.85)
     Outpatient/physician with hypocalcemia30310.7 (0.4 to 0.9)0.7 (0.5 to 0.9)2344691.05.3 (4.6 to 5.9)11.9 (10.8 to 13.0)17.02 (11.83 to 24.48)

    • ICU, intensive care unit; CHF, congestive heart failur; AMI, acute myocardial infarction; ED, emergency department; 95% CI, 95% confidence interval.

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Clinical Outcomes after Parathyroidectomy in a Nationwide Cohort of Patients on Hemodialysis
Areef Ishani, Jiannong Liu, James B. Wetmore, Kimberly A. Lowe, Thy Do, Brian D. Bradbury, Geoffrey A. Block, Allan J. Collins
CJASN Jan 2015, 10 (1) 90-97; DOI: 10.2215/CJN.03520414
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