Long-term kidney outcomes in patients with permanent hypoparathyroidism after total thyroidectomy for benign disease: A population-based study.

Autor: Luk Y; Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong., Fung MMH; Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong., Lui DTW; Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong., Liu X; Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong., Li L; Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong., Wong CKH; Laboratory of Data Discovery for Health (D(2)4H), Hong Kong; Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong; Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong; Department of Infectious Disease Epidemiology & Dynamics, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK., Lang BHH; Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong. Electronic address: blang@hku.hk.
Jazyk: angličtina
Zdroj: Surgery [Surgery] 2024 Sep; Vol. 176 (3), pp. 700-707. Date of Electronic Publication: 2024 Jun 15.
DOI: 10.1016/j.surg.2024.05.005
Abstrakt: Background: Permanent hypoparathyroidism is a significant complication after total thyroidectomy. This study aimed to evaluate the long-term impact of postoperative permanent hypoparathyroidism on kidney outcomes.
Methods: Data of patients undergoing total thyroidectomy from 1999 to 2014 were retrieved. The estimated glomerular filtration rate was determined from serum creatinine results. Permanent hypoparathyroidism was defined as requiring oral calcium and vitamin D supplements postoperatively for at least 6 months. The primary outcome was a sustained decline in the estimated glomerular filtration rate from baseline by ≥50%. Secondary outcomes were end-stage kidney disease (a composite of sustained estimated glomerular filtration rate <15 mL/min/1.73 m 2 , need for dialysis, and kidney transplantation) and rate of estimated glomerular filtration rate decline. Patients with and without permanent hypoparathyroidism were compared. Multivariable Cox regression analysis was performed to identify independent risk factors for sustained estimated glomerular filtration rate decline by ≥50%.
Results: In total, 3,245 patients were eligible for analysis; 418 patients (12.9%) had permanent hypoparathyroidism. Upon median follow-up of 11.6 years, more patients with permanent hypoparathyroidism had a sustained decline in estimated glomerular filtration rate from baseline by ≥50% compared to those without (15.6% vs 6.9%, P < .001). Similar findings were obtained on Kaplan-Meier analysis (P < .001). Permanent hypoparathyroidism was an independent risk factor for sustained estimated glomerular filtration rate decline by ≥50% (adjusted hazard ratio 2.77, P < .001). Other risk factors included age, preoperative estimated glomerular filtration rate <60 mL/min/1.73m 2 , and diabetes mellitus. Patients with permanent hypoparathyroidism had a more rapid estimated glomerular filtration rate decline (-1.60 vs -0.70 mL/min/1.73 m 2 /year, difference -0.91 mL/min/1.73m 2 /year, P < .001).
Conclusion: Patients with postsurgical permanent hypoparathyroidism were at greater risk of renal impairment. Further research is warranted to improve the identification and preservation of parathyroid glands during thyroidectomy to minimize patient morbidity.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: