Effect of Parathyroidectomy on Left Ventricular Performance in Hemodialysis Patients by Echocardiographic Evaluation

Background: In hemodialysis patients, parathyroid hormone is considered a risk factor of cardiovascular disease. Moreover, cardiovascular disease is the leading cause of mortality in hemodialysis patients. The aim of this study was to assess the effect of parathyroidectomy on cardiac performance in hemodialysis patients. Methods: This is a single hospital retrospective analysis on fifteen hemodialysis patients with severe, uncontrolled secondary hyperparathyroidism undergoing parathyroidectomy between 2003 and 2007. Echocardiographic evaluation was performed before and after surgical treatment. Their clinical and biochemical parameters before and after parathyroidectomy were compared. Results: The left ventricular ejection fraction (LVEF) increased significantly after parathyroidectomy (56% vs. 62%, p = 0.005). The pre-operative LVEF value had negative correlation with increment of LVEF. A significant improvement in LVEF after operation was found in the low EF group (LVEF ≤ 51%), whereas not in the high EF group (LVEF ≥ 55%). There were significant differences before and after parathyroidectomy in serum values of total calcium (10.2 vs. 8.9 mg/dL, p < 0.001), phosphate (6.0 vs. 4.1 mg/dL, p = 0.043), Ca × P product (63.3 vs. 36.7 mg/dL , p = 0.013), alkaline phosphatase (117.9 vs. 62 U/L, p = 0.015), hematocrit (31.8 vs. 32.1%, p = 0.041). Conclusion: There was a significant improvement in LVEF after parathyroidectomy by echocardiographic evaluation in hemodialysis patients with hyperparathyroidism, especially with impaired LV function. The serum values of total calcium, phosphate, Ca × P product and hematocrit also became better after surgical treatment. (Acta Nephrologica 2008; 22: 41-48)