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    • Data were analyzed using STATA Stata

    2018-11-02

    Data were analyzed using STATA 12.0 (Stata Corp., College Station, TX, USA) and flecainide acetate reported as the mean ± standard deviation. Natural log or square root transformations were performed when necessary to normalize skewed distributions. Categorical data were compared using Fisher\'s exact test or the Chi-square test, as appropriate. A paired or unpaired Student t test was used to evaluate differences between groups. All statistical tests were two-sided, and statistical significance was determined as p < 0.05.
    Results Of the 386 patients, 346 (90%) were on regular hemodialysis and 40 (10%) were on regular peritoneal dialysis. The peritoneal dialysis patients were significantly younger and had a shorter duration of dialysis compared with the hemodialysis patients (Table 1). The mean duration of dialysis prior to surgery was 9.9 ± 4.9 years and 6.3 ± 3.9 years for the hemodialysis patients and peritoneal dialysis patients, respectively. The peritoneal dialysis patients had lower hemoglobin, albumin, and intact PTH levels compared with the hemodialysis patients. Prior to parathyroidectomy, no differences existed in serum calcium, phosphorus, and alkaline phosphatase levels between the groups. Serum aluminum levels were significantly higher among the peritoneal dialysis patients than among the hemodialysis patients (17.0 ± 11.1 μg/L vs. 13.1 ± 6.7 μg/L, p = 0.039). The majority of patients underwent total parathyroidectomy and autotransplantation (Table 2). Overall, 89 (26%) hemodialysis patients underwent concurrent thyroidectomy for benign goiter (n = 73), thyroiditis (n = 3), or papillary thyroid cancer (n = 13). Six peritoneal dialysis patients underwent concurrent thyroidectomy for benign goiter. The average postoperative hospital stay was 5.0 ± 3.6 days (range, 2–42 days). Both groups showed similar postoperative recovery. Persistent disease was observed in 46 (12%) patients. The dialysis modality did not influence the prevalence of persistent disease. In both groups, serum calcium, phosphorus, alkaline phosphatase, and intact PTH levels decreased significantly after 1 month of parathyroidectomy. During follow-up, intact PTH (Figure 1) and alkaline phosphatase (Figure 2) levels were comparable between the groups. Serum calcium–phosphorus product levels were comparable between the groups prior to surgery and were higher among the peritoneal dialysis patients at 1 month postoperatively (p = 0.001; Figure 3). The difference did not reach statistical significance at 6 (p = 0.082) and 12 months postoperatively (p = 0.342). During a mean follow-up of 3.7 years, 10 (3%) patients developed recurrent hyperparathyroidism. All recurrences occurred beyond 1 year after surgery. Preoperatively, no differences existed in the 13 PAS symptom items between the groups (Figure 4). After parathyroidectomy, peritoneal dialysis patients tended to have more severe residual symptoms in three aspects compared with hemodialysis patients (Figure 5): pain in the bones (p = 0.080), mood swings (p = 0.053), and itchy skin (p = 0.094). The scores for difficulty getting out of a chair or car were similar between the groups (p = 0.337). For hemodialysis patients, a decrease in symptom severity was observed in almost all aspects including bone pain (p = 0.027), mood swings (p = 0.047), itchy skin (p < 0.001), and difficulty getting out of a chair or car (p = 0.006). By contrast, peritoneal dialysis patients did not experience decreases in bone pain (p = 0.224), mood swings (p = 0.546), and itchy skin (p = 0.702).
    Discussion As expected, we found that the surgical patients on peritoneal dialysis were significantly younger. Peritoneal dialysis is a feasible and safe option for elderly patients with ESRD, but old age is associated with the adverse outcomes of peritoneal dialysis-related peritonitis. This is in keeping with the experience of other researchers. In general, elderly patients and patients with peripheral vascular disease, cerebrovascular disease, malignancy, and multiple comorbidities are less likely to receive peritoneal dialysis. In Taiwan, younger patients who received peritoneal dialysis had more favorable survival than patients who received hemodialysis. By contrast, among ESRD patients with cardiovascular disease or diabetes mellitus, peritoneal dialysis may be associated with poor survival.