Investigation of cardiac and blood pressure findings in hemodialysis patients undergoing parathyroidectomy due to secondary hyperparathyroidism

Investigation of Cardiac and Blood Pressure Findings in Hemodialysis Patients Undergoing Parathyroidectomy Due to Secondary Hyperparathyroidism Aim: Improvements in blood pressure and arterial stiffness have been reported after parathyroidectomy in patients with secondary hyperparathyroidism resistant to medical treatment. In fact, some end-stage kidney (SDBY) patients who were hypertensive before the parathyroidectomy operation have been reported to have a sudden drop in blood pressure immediately after parathyroidectomy, and develop postoperative refractory hypotension for years. In this study, it was planned to evaluate whether patients with a history of parathyroidectomy developed diastolic hypotension and to compare 24-hour ambulatory blood pressure follow-up and left ventricular hypertrophy (LVH) findings in HD patients who did not have parathyrodectomy with secondary hyperparathyroidism. Since hypervolemia played an important role in the pathogenesis of hypertension in patients with ESRD, their volume status was evaluated by echocardiography with Inferior Vena Cava (IVC) collapse index. Material and Methods: Echocardiography (ECO), 24-hour ambulatory blood pressure and laboratory data were obtained from 8 male, 8 female HD patients who underwent parathyroidectomy operation, and 8 male, 7 female HD patients with secondary hyperparathyroidism who had secondary hyperparathyroidism as control group. In our study, patients were divided into collapse group (IVC-CI ≥0.5) and noncollapse group (IVC-CI <0.5) according to IVC-collapse index. Average diastolic blood pressure was considered as <60 mmHg diastolic hypotension. Results: In patients included in our study, we could not find a significant difference according to mean blood pressure in any of the 24-hour ambulatory blood pressure scales and LVH between patients with and without a history of parathyroidectomy (p> 0.05). HD duration of patients with a history of parathyroidectomy (165.6 ± 63.2 months) was longer than control patients (74.53 ± 69.2 months) (p=0.001). PTH levels of patients with a history of parathyroidectomy (56.5 ± 77.2) were lower than control patients (899.1 ± 587.2) (p=0.000).The number of patients with IVC collapse index <0.5, that is, with signs of hypervolemia, was statistically significantly higher in the control patient group than in patients undergoing parathyroidectomy (p<0.05). When all patients were evaluated together, patients with IVC collapse index <0.5, ie with signs of hypervolemia, had higher HD inlet and outlet blood pressures and more patients on antihypertensive drugs (p<0.05). In our study, diastolic blood pressures were below 60mmHg in 3 patients with parathyroidectomy history and 3 control patients. 24-hour ambulatory blood pressure values (mean, minimum, maximum systolic and diastolic measurements), mean pulse pressure and HD inlet and outlet blood pressure values of all patients with diastolic blood pressures below 60mmHg were lower than those with diastolic blood pressure 60mmHg and above (p<0.05). %52 of those with diastolic blood pressure 60 mmHg and above were using antihypertensive drugs. Antihypertensive medication was not used in patients with diastolic blood pressure below 60 mmHg. There was no difference between patients with diastolic blood pressures below 60 mmHg and above, in terms of VCI collapse index (p>0.05). In conclusion, patients with a history of parathyroidectomy also have similar blood pressure in patients with secondary hyperparathyroidism and similar left ventricular hypertrophy in echocardiographic examination. We found diastolic hypotension in 3 patients with a history of parathyroidectomy and in 3 patients without parathyroidectomy. Apart from the parathyroid gland, other factors play an important role on blood pressure in HD patients. It does not seem possible to explain a causality between parathyroidectomy and chronic hypertension and hypotension. Larger series and prospective studies are needed to understand the relationship between the removal of the parathyroid gland and changes in calcium homeostasis and blood pressure in chronic dialysis patients. Keywords: Hemodialysis, parathyroidectomy, cardiac, blood pressure.