Impact of dexmedetomidine on secondary hyperparathyroidism recurrence in uremic patients who received parathyroidectomy with auto-transplantation: a retrospective propensity-matched study

Background: Recurrence of secondary hyperparathyroidism (SHPT) remains a big challenge in uremic patients who underwent total parathyroidectomy with auto-transplantation (tPTX-AT). However, the relationship between perioperative intervention and recurrence of SHPT remains unclear. Dexmedetomidine has been used safely and effectively in uremic patients' anesthesia. The aim of the study was to explore the effect of dexmedetomidine on the recurrence of SHPT and identify the possible mechanism of action.

Methods: Records of patients who underwent tPTX-AT between 2017 and 2018 were retrospectively analyzed. The study consisted of patients who received dexmedetomidine intra-operatively and the control patients who did not receive dexmedetomidine. The primary endpoint was the difference in the recurrence of SHPT one year after the surgery between the two groups. The secondary endpoint was health-related quality of life scores. Analysis included propensity score matching and multivariable logistic regression.

Results: Of 354 patients, 133 patients received dexmedetomidine intra-operatively, and the total recurrence rate of SHPT was 10.2%. After propensity score matching, we found that patients' age, dexmedetomidine infusion, comorbidity of diabetes, and preoperative serum phosphorus were independent factors for SHPT recurrence, and that patients who received dexmedetomidine had an estimated 3.80-fold decrease in the risk of SHPT recurrence (odds ratio, 0.263; 95% confidence interval, 0.081 to 0.854; P=0.026). Patients receiving intraoperative dexmedetomidine infusion exhibited a better quality of life in terms of physical functioning and general health, and less emotional role limitations compared with those in the control group.

Conclusion: In uremic patients who received tPTX-AT, there was an association between dexmedetomidine use and decreased risk of SHPT recurrence one year after the surgery. Further studies are needed to accurately assess the effects and mechanism of action of dexmedetomidine on the prognosis of this population.