Patients who receive parathyroidectomy (PTx) rather than cinacalcet for secondary hyperparathyroidism (SHPT) have a lower risk of developing tertiary hyperparathyroidism after receiving a kidney transplant, researchers reported at Kidney Week 2020 Reimagined, the virtual meeting of the American Society of Nephrology.
PTx significantly reduced the risk for tertiary hyperparathyroidism by 51% at 3 years compared with the calcimimetic cinacalcet after adjustments for pre- and perioperative transplant factors, Aarti Mathur, MD, of Johns Hopkins University in Baltimore, Maryland, and colleagues reported. Having no SHPT treatment was associated with a significant 59% lower risk of tertiary hyperparathyroidism.
“Therefore, transplant nephrologists should consider parathyroidectomy for patients with SHPT or monitor patients who received cinacalcet more closely,” Dr Mathur’s team stated.
Their findings were based on data from 12,372 patients on dialysis with SHPT from the Scientific Registry of Transplant Recipients and Medicare claims. Of the cohort, 4554 (36.8%) received cinacalcet, 205 (1.7%) underwent PTx, and 7613 (61.5%) had no SHPT treatment prior to kidney transplant. Annual cinacalcet use increased significantly from 18.4% of patients in 2007 to 46.2% in 2016. Likewise, PTx use significantly increased from 0.8% to 3.1% of patients during the same period. There was no association between SHPT treatment and post-transplant graft failure or death.
Mathur A, Sutton W; Ahn YB, Segev DL, McAdams-DeMarco M. Trends in treatment of secondary hyperparathyroidism and association with post-transplant outcomes. Presented at: Kidney Week 2020 Reimagined, October 19-25, 2020. Poster PO0419.