Serum Levels of Uric Acid and Diabetes Mellitus Influence Survival After Surgery for Primary Hyperparathyroidism: a Prospective Cohort Study

Overview

Journal World J Surg

Publisher Wiley

Specialty General Surgery

Date 2007 May 31

PMID 17534544

Citations 8

Authors

Anders Bergenfelz

Anna Bladstrom

Mark Their

Erik Nordenstrom

Stig Valdemarsson

Johan Westerdahl

Affiliations

Soon will be listed here.

Abstract

Background: Primary hyperparathyroidism (pHPT) is associated with an increased mortality attributable to cardiovascular disease (CVD), suggested to be alleviated by surgery. The exact mechanism of the beneficial influence of parathyroidectomy on survival is unknown. Furthermore, studies suggest that there is no increased mortality compared to the mortality rate in the general population during recent years. This study therefore investigated relative survival (RS), as well overall mortality associated with the clinical and biochemical variables in patients undergoing operation for sporadic pHPT. Furthermore, the influence of surgery on biochemical variables associated with pHPT was analyzed.

Methods: A group of 323 patients with sporadic pHPT operated between September 1989 and July 2003 were followed from surgery over a 10-year period. The median and mean follow-up time was 69 and 70 months, respectively (range: 1-120 months). Relative survival (RS) was calculated, and the impact of clinical and biochemical variables on overall death were evaluated.

Results: Postoperatively, serum levels of triglycerides and uric acid decreased. Glucose levels and glomerular filtration rate remained unchanged. A decreased RS was evident during the latter part of the 10 year follow-up period. In the multivariate Cox-analysis, diabetes mellitus (hazard ratio [HR] = 2.8, 95%; confidence interval [CI] 1.2-6.7), and the combination of an increased level of serum uric acid and cardiovascular disease (CVD) (HR = 8.6, 95%; CI 1.5-49.7) was associated with a higher mortality. The increased risk of death was evident for patients with persistently increased levels of uric acid postoperatively (HR = 4.8, 95%; CI = 1.4-16.01).

Conclusions: Patients undergoing operation for pHPT had a decreased RS during a 10-year follow-up compared to the general population. This decrease in RS is associated with diabetes mellitus and increased levels of uric acid pre-and postoperatively.

Citing Articles

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Mortality after surgery for primary hyperparathyroidism: results from a nationwide cohort.

Nilsson M, Ivarsson K, Thier M, Nordenstrom E, Bergenfelz A, Almquist M Br J Surg. 2021; 108(7):858-863.

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The influence of parathyroidectomy on cardiometabolic risk factors in patients with primary hyperparathyroidism: a systematic review and meta-analysis.

Yavari M, Feizi A, Haghighatdoost F, Ghaffari A, Rezvanian H Endocrine. 2020; 72(1):72-85.

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The Paradoxical Role of Uric Acid in Osteoporosis.

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The role of uric acid in mineral bone disorders in chronic kidney disease.

Afsar B, Sag A, Oztosun C, Kuwabara M, Cozzolino M, Covic A J Nephrol. 2019; 32(5):709-717.

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