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Kidney Week

Abstract: SA-PO704

Clinical Outcomes and Costs of Parathyroidectomy in CKD Patients

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical

Authors

  • Mallett, Andrew John, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
  • Jones, Scott, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
  • Hegerty, Katharine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
  • Scuderi, Carla Elaine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
  • Eglington, Jesseca, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
  • Zhang, Huan, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
  • Broadbent, Toni, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
  • Green, Ben, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
Background

Cinacalcet (CT) for treatment of secondary hyperparathyroidism (SHPT) in chronic kidney disease (CKD) was withdrawn in August 2016 from the Australian Pharmaceutical Benefits Scheme. We aimed to audit parathyroidectomy (PT) for SHPT in CKD, and, to compare PT costs to those of CT therapyin one tertiary Australian centre.

Methods

A retrospective audit of CKD patients with SHPT at a tertiary Australian centre who underwent PT between 1/1/11 and 31/6/17 (n=44) (HREC/17/QRBW/231). Median wait time to renal transplant in Australia is 2.4yrs (range 1.3-4.1yrs) thus centre-specific total cost of 2.4yrs of CT therapy 60mg/day was calculated and compared to the total cost of PT based on hospital records, length of stay (LOS) and peri-operative complications (Cx).

Results

34 and 11 PT were performed respectively in the 67months pre & 11months post August 2016. Median age and body mass index of patients undergoing PT were 51.5yrs (range 24-79yrs) and 29 (range 22-55).
30/34 patients were on dialysis. 5/34 patients were treated according to centre-specific pre-operative protocol. 18/34 patients were treated as per protocol post-operatively.
23/34 patients experienced post-operative Cx/s; ≥2 Cx in 52%. The median LOS post-PT was 6.5days (range 2-35days) with 32% of patients admitted to the intensive care unit. There was a 23.5% re-admission rate within 28 days of PT.
All-cause mortality was 5% at 12months post-PT. A median of 5 outpatient reviews (range 0-37) were required before patients had two consecutive post-operative serum calcium results in normal range whilst on oral therapy. The median follow-up of patients post-PT was 25.5 months.
The mean cost of CT ($13,149/patient) was less than the mean total cost of PT ($23,062/patient; range $11,375-53,279/patient). The median postoperative LOS was 7.51days (range 3.47-35.74days).

Conclusion

PT for SHPT in CKD patients is associated with a significant Cx, protocol non-adherence, re-admission rate and cost. There has been an overall increased annual rate of PT for SHPT in CKD patients. Further, we identified CT to be more cost-effective than PT as a treatment approach in CKD patients with SHPT.Optimised patient selection, protocol review and clinician engagement is indicated to guide best treatment for patients.