Postoperative CKD-MBD profi le and survival after parathyroidectomy in dialysis patients: a retrospective single-centre cohort study

BACKGROUND. Optimal mineral and bone disorder (CKD-MBD) targets after parathyroidectomy (PTX) in dialysis patients remain undefined, and current guidelines do not address this population specifically. 

PATIENTS AND METHODS . This retrospective single-centre cohort study included adult patients on dialysis who underwent subtotal or total PTX with autotransplantation between 2011 and 2019. A total of 485 patients with available preoperative and postoperative laboratory data were analyzed. Serum parathyroid hormone (PTH), phosphate, total and ionized calcium, and alkaline phosphatase were measured before PTX and within predefined postoperative time windows (3–6, 9–12, 24–36 and 48–60 months) to account for intraindividual variability and missing values. The primary endpoint was all-cause mortality; successful kidney transplantation and the end of follow-up were treated as censoring events. Associations between CKD-MBD parameters and survival were examined using Cox proportional hazards models adjusted for demographics, dialysis vintage, primary kidney disease, prior transplantation and type of PTX. 

RESULTS. Preoperative PTH, phosphate and calcium showed no significant linear or non-linear association with survival, either as continuous variables or across quartiles. In contrast, postoperative CKD-MBD status at 3–6 months provided stronger prognostic discrimination. In comparison with the “intermediate” pattern (PTH 150–300 pg/mL, phosphate 0.81–1.45 mmol/L, calcium 2.15–2.50 mmol/L) combinations of low PTH with high or very high phosphate levels were linked to increased risk. Calcium levels were not consistently associated with survival across time windows or categorizations. 

CONCLUSIONS. Long-term survival after PTX in dialysis patients is driven mainly by postoperative phosphate control and maintenance of PTH within an intermediate range, while preoperative CKD-MBD parameters have limited independent prognostic impact.

1. Ketteler M, Evenepoel P, Holden RM et al. Chronic kidney disease-mineral and bone disorder: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int 2025;107(3):405–423. doi:10.1016/j.kint.2024.11.013

2. Клинические рекомендации «Хроническая болезнь почек (ХБП)». 2024. Доступно по: https://cr.minzdrav.gov.ru/previewcr/469_3 (дата обращения: 01.02.2026)

3. Sleptsov IV, Vybornova NB, Chernikov RA et al. Modified quick parathyroid hormone test in surgery of primary hyperparathyroidism. Endocrine Surgery 2015;9(4):12–21. (In Russ.) doi:10.14341/ serg2015412-21

4. Evenepoel P, Jørgensen HS. Parathyroidectomy versus calcimimetic: the lower the PTH the better? J Clin Endocrinol Metab 2022;107(8):e3532–e3533. doi:10.1210/clinem/dgac211

5. Parshina EV, Gerasimchuk RP, Zemchenkov AYu. Comparison of the outcomes of correction of secondary hyperparathyroidism by parathyroidectomy and etelcalcetide therapy in real clinical practice. Nephrology (Saint-Petersburg) 2025;29(3):67–76. (In Russ.) doi:10.36485/1561-6274-2025-29-3-67-76

6. Parshina EV, Tolkach AD, Novokshonov KYu et al. The relationship between previous cinacalcet therapy and the course of hungry bone syndrome in patients who underwent surgery for secondary hyperparathyroidism. Nephrology and Dialysis 2026;28(2):____ (In Russ.)

7. Novokshonov K, Karelina J, Zemchenkov A et al. Chronic kidney disease mineral and bone disorder markers in screening study among dialysis patients in North-West federal region of Russia. Nephrology (Saint-Petersburg) 2016;20(1):36–50. (In Russ.)

8. Parshina EV, Zemchenkov AYu, Novokshonov KYu, Chernikov RA. Comment on the paper by D.D. Dolidze et al.: Secondary hyperparathyroidism. Specific features, complexity, features of treatment (literature review). Part II Surgical treatment. Nephrology and Dialysis 2024;26(2):242–245. (In Russ.) doi:10.28996/2618-98012024-2-242-245

9. Vishnevskii KA, Parshina EV, Zemchenkov AYu et al. Analysis of patients’ survival on renal replacement therapy in a large city: a multicenter prospective cohort observational study. Nephrology and Dialysis 2025;27(1):59–79. (In Russ.) doi:10.28996/2618-98012025-1-59-79

10. Fotheringham J, Balasubramanian SP, Harrison B, Wilkie M. Post-parathyroidectomy parathyroid hormone levels: the impact on patient survival in a stage 5 chronic kidney disease population. Nephron Clin Pract 2011;119(2):c113–c120. doi:10.1159/000326683

11. Xi QP, Xie XS, Zhang L et al. Impact of different levels of iPTH on all-cause mortality in dialysis patients with secondary hyperparathyroidism after parathyroidectomy. Biomed Res Int 2017;2017:6934706. doi:10.1155/2017/6934706

12. Luo C, Bian X, Ji C et al. Association between serum intact parathyroid hormone and survival in dialysis patients. Int Urol Nephrol 2025;57(3):1019–1028. doi:10.1007/s11255-024-04288-y

13. Zhou X, Guo Y, Luo Y. The optimal range of serum intact parathyroid hormone for a lower risk of mortality in incident hemodialysis patients. Ren Fail 2021;43(1):599–605. doi:10.1080/08860 22X.2021.1903927

14. Guo W, Zhang H, Zhang Y et al. Low parathyroid hormone versus secondary hyperparathyroidism and survival in patients undergoing hemodialysis: a propensity-matched analysis. Front Endocrinol (Lausanne) 2022;13:869330. doi:10.3389/fendo.2022.869330

15. Song Z, Wu C, Wang R et al. The effects of parathyroidectomy vs medical treatments for secondary hyperparathyroidism in patients undergoing dialysis: a meta-analysis. Endocr Pract 2024;30(6):569576. doi:10.1016/j.eprac.2024.04.002

16. Song Z, Kasmirski J, Balachandra S et al. Parathyroidectomy is associated with lower mortality and fewer cardiac complications in patients with secondary hyperparathyroidism. Surgery 2026;189:109851. doi:10.1016/j.surg.2025.109851

17. Komaba H, Hamano T, Fujii N et al. Parathyroidectomy vs cinacalcet among patients undergoing hemodialysis. J Clin Endocrinol Metab 2022;107(7):2016–2025. doi:10.1210/clinem/dgac142

18. Yang T, Xue Y, Ren J et al. Analysis of factors influencing cardiovascular events and mortality in patients on dialysis after parathyroidectomy. Curr Pharm Des 2025;31(33):2691–2704. doi: 10.21 74/0113816128390373250507062606

19. Hernandes FR, Canziani ME, Barreto FC et al. The shift from high to low turnover bone disease after parathyroidectomy is associated with the progression of vascular calcification in hemodialysis patients: a 12?month follow?up study. PLoS One 2017;12(4):e0174811. doi:10.1371/journal.pone.0174811

20. Nascimento Junior CP, Arap SS, Custodio MR et al. Parathyroid hormone levels after parathyroidectomy for secondary hyperparathyroidism. Rev Assoc Med Bras (1992) 2021;67(2):230–234. doi:10.1590/1806-9282.67.02.20200609

21. Zmijewski PV, Staloff JA, Wozniak MJ, Mazzaglia PJ. Subtotal parathyroidectomy vs total parathyroidectomy with autotransplantation for secondary hyperparathyroidism in dialysis patients: shortand long-term outcomes. J Am Coll Surg 2019;228(6):831–838. doi:10.1016/j.jamcollsurg.2019.01.019

22. Yang L, Zhang NR, Wang HF et al. Evaluation of long-term effects of parathyroidectomy in patients with refractory secondary hyperparathyroidism. Hemodial Int 2025;29(3):354–362. doi:10.1111/ hdi.13222

23. Yang L, Zhang NR, Wang HF, Chen JN, Yang M, Sun XL, Lv Y, Lu Y, Jia WN, He WW, Zhang L. Evaluation of long-term effects of parathyroidectomy in patients with refractory secondary hyperparathyroidism. Hemodial Int 2025;29(3):354–362. doi:10.1111/hdi.13222. Epub 2025 Apr 4. PMID:40183161

24. Kuo YC, Wang SY, Hung YL et al. Risk factors of recurrent secondary hyperparathyroidism after adequate primary surgical treatment. Front Endocrinol (Lausanne) 2023;14:1063837. doi:10.3389/ fendo.2023.1063837

25. Alvarado L, Sharma N, Lerma R et al. Parathyroidectomy versus cinacalcet for the treatment of secondary hyperparathyroidism in hemodialysis patients. World J Surg 2022;46(4):813–819. doi:10.1007/s00268-022-06439-7

26. Tartaglione L, Rotondi S, Aucella F et al. Parathyroidectomy and survival in a cohort of Italian dialysis patients: results of a multicenter, observational, prospective study. J Nephrol 2023;36(7):19471955. doi:10.1007/s40620-023-01658-0

27. Koimtzis G, Stefanopoulos L, Geropoulos G et al. Calcimimetics or parathyroidectomy for kidney transplant recipients: is there still a question? A systematic review, meta-analysis and trial sequential analysis. Endocrine 2025;88(3):671–681. doi:10.1007/ s12020-025-04189-9