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Abstract: FR-PO129

Parathyroidectomy vs. Cinacalcet for Secondary Hyperparathyroidism in Patients Undergoing Hemodialysis

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical

Authors

  • Komaba, Hirotaka, Japanese Society for Dialysis Therapy, Tokyo, Japan
  • Hamano, Takayuki, Japanese Society for Dialysis Therapy, Tokyo, Japan
  • Fujii, Naohiko, Japanese Society for Dialysis Therapy, Tokyo, Japan
  • Wada, Atsushi, Japanese Society for Dialysis Therapy, Tokyo, Japan
  • Masakane, Ikuto, Japanese Society for Dialysis Therapy, Tokyo, Japan
  • Nitta, Kosaku, Japanese Society for Dialysis Therapy, Tokyo, Japan
  • Fukagawa, Masafumi, Tokai University School of Medicine, Isehara, Japan
Background

Parathyroidectomy (PTx) and cinacalcet are both effective in treating secondary hyperparathyroidism in patients undergoing hemodialysis. However, there is a paucity of data comparing the long-term outcomes of these treatments.

Methods

We analyzed data from a nationwide cohort of hemodialysis patients in Japan who had intact parathyroid hormone (PTH) levels >300 pg/ml and no history of prior PTx on December 2007. Patients who underwent PTx or initiated cinacalcet between January 2008 and December 2009 were matched for baseline intact PTH levels and propensity score in a 1:3 ratio. Mortality follow-up started on December 2009 and continued until December 2015. Mortality risk was assessed using Cox proportional hazards models.

Results

A total of 894 patients who underwent PTx and 2,682 patients who initiated cinacalcet had similar propensity scores and were included in the analysis. Median baseline intact PTH levels were 588 pg/ml (interquartile range [IQR], 422-809 pg/ml) and 566 pg/ml (IQR, 427-777 pg/ml) in the PTx and cinacalcet groups, respectively. Following either treatment, the intact PTH levels decreased to 83 pg/ml (IQR, 19-225 pg/ml) in the PTx group and 218 pg/ml (IQR, 138-364 pg/ml) in the cinacalcet group. During the 6-year of follow-up period, 201 patients in the PTx group and 736 patients in the cinacalcet group died. PTx was associated with a significantly lower risk of death compared with cinacalcet (hazard ratio, 0.78; 95% confidence interval, 0.67-0.91). The survival benefit associated with PTx versus cinacalcet was more pronounced in patients with baseline intact PTH levels >500 pg/ml and in patients with baseline serum calcium levels >10.0 mg/dl (both P <0.001 for interaction). The difference in mortality between PTx and cinacalcet was attenuated by adjustments for time-varying intact PTH, calcium, and phosphorus levels.

Conclusion

PTx compared with cinacalcet is associated with a lower risk of death, particularly among patients with severe secondary hyperparathyroidism.