Abstract: SA-PO282
Suboptimal Screening of Primary Hyperparathyroidism Among Veterans with Urinary Stone Disease
Session Information
- Bone and Mineral Metabolism: Calcium, Magnesium, Kidney Stones
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Bone and Mineral Metabolism
- 402 Bone and Mineral Metabolism: Clinical
Authors
- Ganesan, Calyani, Stanford University, Palo Alto, California, United States
- Weia, Benjamin C., Stanford Healthcare, Palo Alto, California, United States
- Thomas, I-Chun, VA Palo Alto, Palo Alto, California, United States
- Song, Shen, Stanford University School of Medicine, Palo Alto, California, United States
- Sohlberg, Ericka M., Stanford University, Palo Alto, California, United States
- Elliott, Christopher S., Stanford University, Palo Alto, California, United States
- Conti, Simon, Stanford University, Palo Alto, California, United States
- Liao, Joseph C., Stanford University, Palo Alto, California, United States
- Chertow, Glenn Matthew, Stanford University School of Medicine, Palo Alto, California, United States
- Leppert, John, Stanford University, Palo Alto, California, United States
- Pao, Alan C., Stanford University, Palo Alto, California, United States
Background
The American Association of Endocrine Surgeons recommends parathyroidectomy in stone formers with primary hyperparathyroidism to prevent osteopenia, osteoporosis, and recurrent urinary stones. However, rates of screening for primary hyperparathyroidism among stone formers remain unknown. To address this knowledge gap, we determined the rate of parathyroid hormone (PTH) testing in a national cohort of stone formers with hypercalcemia in the Veterans Health Administration (VHA).
Methods
We identified stone formers as Veterans with one or more inpatient or two or more outpatient encounters for urinary stone disease (USD), or one or more stone procedures between 2008 and 2013 using the national VHA database. We excluded patients who were previously screened for hyperparathyroidism and those with an eGFR < 45 to avoid identifying Veterans with secondary hyperparathyroidism. We first identified the highest serum calcium measurement within a 6 month period before and after initial stone diagnosis. We then identified associated serum PTH concentrations within 9 months of initial stone diagnosis.
Results
We identified 140,181 stone formers who met criteria of whom 94.7% (132,787 individuals) were men. Within this cohort, 85% (119,197 individuals) had a serum calcium level measured; of these, 1.8% (2,142 individuals) were found to have at least one serum calcium concentration > 10.5 mg/dL. Among patients with hypercalcemia, 24.4% (523 individuals) had a serum PTH measurement, and 51.8% (271 individuals) of these had serum PTH concentrations above the population reference range, suggesting primary hyperparathyroidism
Conclusion
Among Veterans with USD, hypercalcemia, and normal or near normal kidney function, fewer than one in four undergo PTH testing, and among those who do, more than half have evidence of primary hyperparathyroidism. The majority of stone formers with hypercalcemia and normal or near normal kidney function are not screened for primary hyperparathyroidism, a treatable cause of USD. This information should raise clinical awareness about deficits in guideline-concordant care and inform future quality-improvement efforts in USD care.
Funding
- Veterans Affairs Support