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Parathyroidectomized patients have impaired capacity of peripheral vascular constriction during hemodialysis
Author(s) -
Silva Bruno C.,
Moysés Rosa M. A.,
Silva Vitor B.,
Freitas Geraldo R. R.,
Elias Rosilene M.
Publication year - 2016
Publication title -
hemodialysis international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.658
H-Index - 47
eISSN - 1542-4758
pISSN - 1492-7535
DOI - 10.1111/hdi.12309
Subject(s) - medicine , hemodialysis , vascular resistance , blood pressure , parathyroidectomy , hemodynamics , cardiology , vasoconstriction , prospective cohort study , parathyroid hormone , peripheral , endocrinology , cardiac index , heart rate , calcium
Parathyroidectomy ( PTx ) seems to improve cardiovascular outcomes and reduce blood pressure levels. However, the effect of PTx on hemodynamic changes during hemodialysis ( HD ) is still overlooked. This was a prospective cohort design. Patients with end‐stage renal disease on maintenance HD were included. Diabetes and nonsinusal rhythm were exclusion criteria. History of PTx was recorded. Finometer monitor was used to access parameters immediately pre‐ and post‐ HD sessions. Cardiac index ( CI ) variation (Δ CI ) and peripheral arterial resistance variation (Δ PAR ) were the variables of interest. Biochemical and echocardiographic data were also obtained. PTx patients (n = 11) were matched to non‐ PTx patients (n = 20). Δ PAR was lower in PTx group in comparison with non‐ PTx group (P = 0.039), which was independent of parathyroid hormone ( PTH ) levels. Multiple regression analysis showed that PTx , Δ CI , and dialysate calcium remained independently associated with PAR variation and even adjusted for ultrafiltration rate (adjusted r 2 = 0.64). In conclusion, parathyroidectomized patients have impaired capacity of vasoconstriction in response to ultrafiltration, an effect independent of serum PTH levels. Further studies are needed to elucidate mechanisms explaining the interaction between PTx and systemic vascular tonus.