Abstract: 【Abstract】Objective To study the risk factors for all- cause death and major cardiovascular events (MACE) in maintenance hemodialysis (MHD) patients, especially the role of parathyroid (PT) hyperplasia in the death and MACE in MHD patients. Methods We recruited the MHD patients treated in our dialysis center from July 2013 to July 2019. Their prognosis, MACE, coronary artery calcium score (CACS), and PT hyperplasia from ultrasonography were collected and analyzed by statistical methods. Results A total of 70 MHD patients were enrolled in this study. The median follow-up period was 71 months, the mean age of the patients was 60.07±13.62 years, and the mean dialysis duration was 58.37±50.17 months. During the followup period, 44.3% of the patients died, and 34.3% of the patients had MACE. Age (t=-3.707, P<0.001), prevalence of PT hyperplasia (χ2=8.504, P=0.004) and CACS (Z=-3.536, P＜0.001) were significantly higher in the death patients than in the survival patients (P＜0.05); but serum phosphorus (t=- 1.222, P=0.226) and iPTH (t=1.877, P=0.065) were similar between the two groups of patients. Multivariant Cox regression analysis showed that PT hyperplasia and age were the independent risk factors for all-cause death (PT hyperplasia: HR=2.422, 95% CI 1.081~5.427, P=0.032; age: HR=1.054, 95% CI 1.013~1.097, P=0.032) and MACE (PT hyperplasia: HR= 9.117, 95%CI 2.195~37.877, P=0.002; age: HR=1.055, 95%CI 1.003~1.110, P=0.036). Survival analysis showed that the rates of all- cause death (P=0.016) and MACE (P=0.009) were significantly higher in patients with PT hyperplasia than in those without PT hyperplasia. Analysis of the related factors for PT hyperplasia found that higher serum phosphorus (OR=125.805, 95% CI 5.009 ~ 3159.418, P=0.003) and longer duration of dialysis (OR=1.023, 95% CI 1.000~1.046, P=0.047) were the independent risk factors for PT hyperplasia. Conclusion PT hyperplasia is a risk factor for all-cause death and MACE, and higher serum phosphorus is an independent risk factor for PT hyperplasia. These results suggest that early clinical intervention of risk factors for PT hyperplasia, such as hyperphosphatemia, are useful measures for reducing allcause mortality and MACE.

Key words: Hemodialysis, Parathyroid hyperplasia, Cardiovascular disease, Risk factor