Abstract: Objective To explore the effects of parathyroidectomy (PTX) on serum phosphate level and bone metabolism in uremic hemodialysis patients, and to analyze the primary factors which affect serum phosphate level. Method Uremic patients with secondary hyperparathyroidism treated with PTX in our hospital during the period from Jan. 2008 to Dec. 2013 were enrolled in this study. Serum and plasma samples were collected before PTX and after PTX for 1, 3 and 7 days and clinical data were recruited. Correlations among these data were analyzed. Result Serum PTH significantly decreased after PTX for one day as compared with the level before PTX. Serum phosphate decreased from 2.26±0.55 mmol/L before PTX to 1.37± 0.40 mmol/L after PTX for 3 days (P＜0.01). Plasma FGF23 also decreased gradually after PTX. Plasma FGF23 decreased from 680.75±307.71 pg/mL before PTX to 418.65±280.74 pg/mL after PTX for 7 days (P＜0.01). Serum bone- specific alkaline phosphatase (BAP) reduced from 727.50 ± 30.14 U/L before PTX to 551.25±60.61 U/L after PTX for one day (P＜0.01). Serum type I collagen cross-linked C-terminal peptide (ICTP) decreased from 20.11±2.56 μg/L before PTX to 13.75±2.95 μg/L after PTX for one day (P＜0.05).Pearson correlation analysis found that serum phosphate level correlated with the levels of serum PTH, calcium, FGF23, 25(OH)D3 BAP and ICTP. Multivariate regression analysis demonstrated that FGF23 was the factor determining serum phosphate level. Conclusion Parathyroidectomy significantly alleviates the higher serum phosphate and improves bone metabolism. Bone derived FGF23 is a decisive factor on serum phosphate level.

Key words: Parathyroidectomy, Hyperphosphatemia, Fibroblast growth factor 23, Bone metabolism