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Open Access Research article

Temporal trends and risk factors for parathyroidectomy in the Swedish dialysis and transplant population – a nationwide, population-based study 1991 – 2009

Shahriar Akaberi1*, Naomi Clyne1, Gunnar Sterner2, Bengt Rippe1, Eva Reihnér38, Philippe Wagner4, Rebecca Rylance4, Karl Göran Prütz57 and Martin Almquist6

Author Affiliations

1 Department of Nephrology, Clinical Sciences Lund, Lund University, Alwallhuset, Barngatan 2A, Lund 221 85, Sweden

2 Department of Nephrology, Clinical Sciences Malmö, Lund University, Lund, Sweden

3 Department of Molecular Medicine and Surgery, Karolinska Institute, Section of Endocrine Surgery, Karolinska University Hospital, Stockholm, Sweden

4 National Registry Centre, Skane University Hospital, Lund, Sweden

5 Department of Internal Medicine, Helsingborg Hospital, Helsingborg, Sweden

6 Section of Endocrine and Sarcoma Surgery, Department of Surgery, Skane University Hospital, Lund, Sweden

7 Swedish Renal Registry, Ryhov Hospital, Jönköping, Sweden

8 Scandinavian Quality Register for Thyroid Parathyroid and Adrenal Surgery, Helsingborg, Sweden

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BMC Nephrology 2014, 15:75  doi:10.1186/1471-2369-15-75

Published: 8 May 2014

Abstract

Background

Many patients on renal replacement therapy (RRT) require parathyroidectomy (PTX). Trends and current rates of PTX on a national level are not known. Furthermore, it is not completely clear which factors influence rates of PTX. Thus, our aim was to investigate the incidence, regional distribution and factors associated with PTX as well as possible temporal changes, in the Swedish RRT population.

Methods

From the Swedish Renal Registry we extracted data on 20 015 patients on RRT between 1991 and 2009. In these, 679 incident PTX (3.4%) were identified by linkage with the National Inpatient Registry, and the Scandinavian Quality Registry for Thyroid Parathyroid and Adrenal Surgery. Poisson models were used to estimate rates per calendar year, adjusted for risk factors such as gender, age, time with renal transplant, and underlying cause of renal disease.

Results

The PTX rate was 8.8/1 000 person-years. There was a significant increase 2001–2004 after which the rate fell, as compared with year 2000. Female gender, non-diabetic cause of renal disease and age between 40–55 were all associated with an increased frequency of PTX.

Conclusion

The rise in PTX rates after year 2000 might reflect increasing awareness of the potential benefits of PTX. The introduction of calcimimetics and paricalcitol might explain the decreased rate after 2005.

Keywords:
End stage renal disease; Dialysis; Renal transplantation; Secondary hyperparathyroidism; Parathyroidectomy