Risk of acute coronary syndrome after parathyroidectomy in patients with end‐stage renal disease: A population‐based cohort study in Taiwan

• Published in: Nephrology (Carlton, Vic.) Vic.), 2018-02, Vol.23 (2), p.139-147
• Main Authors: Ma, Tsung Liang, Chang, Rei Yeuh, Chen, Hsuan Ju, Liu, Chun Yi, Hsu, Chih Cheng, Hsu, Yueh Han
• Format: Article
• Language: English
• Subjects: Acute Coronary Syndrome - diagnosis; Acute Coronary Syndrome - epidemiology; Acute Coronary Syndrome - prevention & control; Acute coronary syndromes; Administrative Claims, Healthcare; Adolescent; Adult; Aged; Cohort analysis; Databases, Factual; Dialysis; End-stage renal disease; Female; Humans; Hyperparathyroidism, Secondary - diagnosis; Hyperparathyroidism, Secondary - epidemiology; Hyperparathyroidism, Secondary - surgery; Incidence; Insurance claims; Kidney diseases; Kidney Failure, Chronic - diagnosis; Kidney Failure, Chronic - epidemiology; Kidney Failure, Chronic - therapy; Male; Medicare; Middle Aged; Multivariate Analysis; Original; Parathyroid; Parathyroid hormone; Parathyroidectomy; Population studies; Population-based studies; Propensity Score; Proportional Hazards Models; Protective Factors; Retrospective Studies; Risk Assessment; Risk Factors; Taiwan - epidemiology; Time Factors; Treatment Outcome; Young Adult
• ISSN: 1320-5358; 1440-1797
• DOI: 10.1111/nep.12958

Aim Patients with end‐stage renal disease (ESRD) who received parathyroidectomy (PTX) had persistently reduced levels of parathyroid hormone. This study investigated the risk of acute coronary syndrome (ACS) in patients with ESRD who underwent PTX using a nationwide health insurance claims database. Methods Of all ESRD patients, we selected 1047 individuals who had undergone PTX between 2000 and 2008 as the PTX group and 4188 patients who did not undergo PTX (non‐PTX group) matched by propensity score. Multivariable Cox proportional hazards regression analysis was conducted for assessing the excess ACS risk for the PTX group compared to the non‐PTX group. Results The mean follow‐up periods were 4.63 and 4.04 years for the PTX and non‐PTX groups, respectively. A significant reduction in the risk of ACS (adjusted hazard ratio = 0.74, 95% confidence interval = 0.57–0.96) was observed for the ESRD patients after PTX. Conclusions Parathyroidectomy is associated with reduced risk of ACS in patients with ESRD. Summary at a Glance From a national health insurance claims database, this study matched patients receiving dialysis who had a parathyroidectomy to patients who did not, using a propensity score method. They demonstrate that patients who had a parathyroidectomy were less likely to experience an acute coronary syndrome in the ensuing 4 years.