The effect of Parathyroidectomy compared to pharmacological treatment on biochemical markers and quality of life among maintenance hemodialysis patients with secondary hyperparathyroidism

Background One-third of maintenance hemodialysis (HD) patients develop severe secondary hyperparathyroidism (SHPT). Parathyroidectomy (PTx) is recommended for resistant SHPT, but calcimimetics have reduced the need for surgery. Aim of the work: to compare biochemical and QoL parameters in HD patients with SHPT who underwent PTx to those treated medically. Subject and methods in a cross-sectional study, 200 maintenance HD patients in two equal groups: A (patients on medical treatment) and B (PTx patients). In Group A, 32 patients received Cinacalcet. A thorough history, anthropometrics, clinical examination, Electrocardiography and full laboratory tests including serum calcium (sCa), phosphorus (sPhos), intact parathormone (iPTH) were performed. QoL was assessed using the Ferrans and Powers Quality of Life Index, generic version III. Results PTx group has significantly lower sPhos, and iPTH but significantly higher sCa, s.ferritin, TIBC, social/economic, psychological/spiritual, and total QoL domains compared to medical TTT group. Additionally, PTx patients had higher sCa, but lower sPhos, and iPTH than Calcimimetic patients. PTx group had a higher social/economic, Psychological/spiritual and total QoL scores compared to the calcimimetic group (24.95±2.45 vs 20.16±2.67, p=0.022), (26.48 ± 1.06 vs. 19.23 ± 1.34, p