Surreal illustration of healthy heart and kidneys intertwined with bone structures.

Kidney Disease and Heart Health: Can Parathyroidectomy Help?

Nico Varela in Health & Wellness November 2025 • 4 min read.

"Discover how parathyroidectomy (PTX) can improve heart rate variability (HRV) in chronic kidney disease patients by correcting bone markers and reducing sympathetic hyperactivity."

Cardiovascular disease (CVD) is a major health threat for individuals with chronic kidney disease (CKD). The risk of cardiovascular issues and sudden death rises significantly due to changes in the cardiac autonomic nervous system, especially overactivity of the sympathetic nervous system (SNS). This overactivity can be measured through heart rate variability (HRV), a crucial indicator of cardiac autonomic function.

Chronic kidney disease–mineral and bone disorder (CKD-MBD) is another frequent issue in CKD patients. It involves problems with mineral and bone metabolism, bone structure, and vascular calcification, all of which raise the risk of CVD and mortality. A common treatment for severe secondary hyperparathyroidism (SHPT) which contributes to bone pain, fractures, CVD, and increased mortality is parathyroidectomy (PTX).

A recent study has explored the connection between circulating bone markers and heart rate variability (HRV) in CKD patients. The findings indicate that parathyroidectomy (PTX) can enhance heart rate variability (HRV) by addressing specific bone markers and reducing sympathetic overactivity. This offers new hope for improving both kidney and heart health in this patient population.

How Does Parathyroidectomy (PTX) Improve Heart Health in CKD Patients?

Surreal illustration of healthy heart and kidneys intertwined with bone structures.

The study, published in International Urology and Nephrology, examined the effects of parathyroidectomy (PTX) on blood bone markers and heart rate variability (HRV) in patients with stage 5 chronic kidney disease. Researchers conducted a cross-sectional study involving 134 stage 5 CKD patients and 100 controls, along with a prospective study of 29 PTX patients with follow-up data.

The study focused on several key bone biomarkers:

Intact parathyroid hormone (iPTH): Regulates bone remodeling.
Bone-specific alkaline phosphatase (BAP): Indicates bone formation.
Tartrate-resistant acid phosphatase 5b (TRACP-5b): Indicates bone resorption.
Fibroblast growth factor 23 (FGF23): A bone-derived hormone.

The study revealed significant improvements in heart rate variability (HRV) following parathyroidectomy (PTX), which were directly associated with the normalization of bone markers. This suggests that PTX can reduce sympathetic tone and correct the imbalances in bone turnover, ultimately benefiting cardiovascular health. These findings highlight a promising avenue for integrated treatment strategies that address both kidney and heart health in CKD patients.

Looking Ahead: Improving the Future of CKD and Heart Health

The insights from this study offer new possibilities for managing CKD-MBD patients and reducing their cardiovascular risk. However, further research is needed to fully understand the interactions between bone markers, heart rate variability, and cardiovascular outcomes. By establishing the diagnostic and prognostic value of circulating bone biomarkers, healthcare professionals can develop more effective and integrated treatment strategies to improve the quality of life and overall health for individuals with chronic kidney disease.

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Everything You Need To Know

What exactly is a parathyroidectomy (PTX)?

Parathyroidectomy, or PTX, is a surgical procedure that involves the removal of one or more of the parathyroid glands. It's often used to treat severe secondary hyperparathyroidism (SHPT) in people with chronic kidney disease (CKD). SHPT contributes to bone pain, fractures, cardiovascular disease, and increased mortality. By removing the parathyroid glands, parathyroidectomy (PTX) helps to regulate mineral and bone metabolism, bone structure, and vascular calcification.

What does heart rate variability (HRV) mean, and why is it important for people with kidney disease?

Heart rate variability, or HRV, is a measure of the variation in time between successive heartbeats. It's an important indicator of cardiac autonomic function, which reflects the balance between the sympathetic and parasympathetic nervous systems. Higher heart rate variability (HRV) generally indicates better adaptability and resilience of the heart. In individuals with chronic kidney disease (CKD), reduced heart rate variability (HRV) is often observed due to increased sympathetic nervous system (SNS) activity, which elevates the risk of cardiovascular issues and sudden death.

What is chronic kidney disease–mineral and bone disorder (CKD-MBD)?

Chronic kidney disease–mineral and bone disorder, or CKD-MBD, is a common complication in chronic kidney disease (CKD) patients. It involves abnormalities in mineral and bone metabolism, bone structure, and vascular calcification. These issues significantly increase the risk of cardiovascular disease (CVD) and mortality in this population. Key bone markers, such as intact parathyroid hormone (iPTH), bone-specific alkaline phosphatase (BAP), tartrate-resistant acid phosphatase 5b (TRACP-5b), and fibroblast growth factor 23 (FGF23), are often affected in CKD-MBD.

How does parathyroidectomy (PTX) affect heart health in patients with chronic kidney disease (CKD)?

The study showed that parathyroidectomy (PTX) improves heart rate variability (HRV) in stage 5 chronic kidney disease (CKD) patients by normalizing bone markers and reducing sympathetic overactivity. Specific bone markers like intact parathyroid hormone (iPTH), bone-specific alkaline phosphatase (BAP), tartrate-resistant acid phosphatase 5b (TRACP-5b), and fibroblast growth factor 23 (FGF23) were targeted, leading to enhanced heart rate variability (HRV). This improvement in heart rate variability (HRV) indicates better cardiac autonomic function and reduced cardiovascular risk. This approach addresses both kidney and heart health.

Why are bone markers like intact parathyroid hormone (iPTH) and fibroblast growth factor 23 (FGF23) important in chronic kidney disease (CKD)?

Bone markers like intact parathyroid hormone (iPTH), bone-specific alkaline phosphatase (BAP), tartrate-resistant acid phosphatase 5b (TRACP-5b), and fibroblast growth factor 23 (FGF23) are important because they reflect the state of bone metabolism in chronic kidney disease (CKD) patients. Intact parathyroid hormone (iPTH) regulates bone remodeling, bone-specific alkaline phosphatase (BAP) indicates bone formation, tartrate-resistant acid phosphatase 5b (TRACP-5b) indicates bone resorption, and fibroblast growth factor 23 (FGF23) is a bone-derived hormone. Monitoring these markers helps healthcare professionals understand the severity of CKD-MBD and assess the effectiveness of treatments like parathyroidectomy (PTX).