Vascular calcification progression after parathyroidectomy in patients on renal replacement therapy: a pilot study

Objective: to evaluate the progression of vascular calcification in dialysis-dependent patients following parathyroidectomy (PTX) for secondary hyperparathyroidism (SHPT) over long-term follow-up. Materials and methods. This prospective cohort study included 63 adult patients with stage 5 chronic kidney disease receiving renal replacement therapy. The main group (n = 55) underwent successful PTX for SHPT, while the control group (n = 8) received medical therapy. Cardiac computed tomography was performed to assess the coronary artery calcification (CAC) index, and lateral abdominal radiography was used for semi-quantitative assessment of abdominal aortic calcification (AAC). Assessments were conducted at baseline and after 18 months of follow-up. Results. The primary analysis included 44 patients in the PTX group and 6 in the control group who completed follow-up. The mean change in CAC was +452 (95% CI: –223 to 891; p = 0.101) in the PTX group and +1432 (95% CI: –772 to 2778; p = 0.065) in controls, with no significant between-group difference (Δ = –980; 95% CI: –2631 to 1542; p = 0.434). For AAC, the mean change was 0 points (95% CI: –1 to 1; p = 0.775) in the PTX group and +3 points (95% CI: –0.2 to 5.8; p = 0.038) in controls; the between-group difference approached significance (Δ = –2.9; 95% CI: –6.3 to 0.54; p = 0.098). Following PTX, serum calcium and phosphate levels decreased by 0.13 (0.29) mmol/L (p = 0.003) and 0.25 (0.64) mmol/L (p = 0.013), respectively, while remaining unchanged in the control group (effect sizes: 0.52 SD and 0.31 SD). Achieving target parathyroid hormone (PTH <15 pmol/L), along with normalized calcium and phosphate levels and statin therapy, was linked to an 85% reduction in the risk of calcification progression (95% CI: –98% to –0.01%; p = 0.050; R² = 0.400). Conclusions. Differences in vascular calcification progression did not reach statistical significance for the primary endpoint, likely due to the small control group and heterogeneity of effects. However, significant progression of AAC was observed in the control group but not in the PTX group. These findings suggest potential clinical relevance, although results should be interpreted only in the context of clinical significance and can be used in future studies.

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