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Abstract: PO0419

Trends in Treatment of Secondary Hyperparathyroidism and Association with Post-Transplant Outcomes

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical

Authors

  • Mathur, Aarti, Johns Hopkins University, Baltimore, Maryland, United States
  • Sutton, Whitney, Johns Hopkins University, Baltimore, Maryland, United States
  • Ahn, JiYoon B., Johns Hopkins University, Baltimore, Maryland, United States
  • Segev, Dorry L., Johns Hopkins University, Baltimore, Maryland, United States
  • McAdams-DeMarco, Mara, Johns Hopkins University, Baltimore, Maryland, United States
Background

Secondary hyperparathyroidism(SHPTH) affects nearly all patients with kidney failure on maintenance dialysis and has been independently associated with increased mortality and cardiovascular disorders. Treatment includes vitamin D analogs, calcimimetics, or parathyroidectomy. However, treatment choice for SHPTH on outcomes after kidney transplantation(KT) is not well understood. The primary objectives of our study were to understand treatment trends in SHPTH and their association with post-transplant outcomes.

Methods

Using SRTR and Medicare claims data, we identified 12,372 adults(age≥18) who received KT in 2007-2016 and had a diagnosis of SHPTH during dialysis. We examined the association between treatment method for SHPTH and development of tertiary hyperparathyroidism,delayed graft function,graft failure,and death using adjusted Cox proportional hazards models.

Results

Of 12,372 patients with a diagnosis of SHPTH, 4,554(36.8%) received cinacalcet, 205(1.7%) underwent parathyroidectomy, and 7,613(61.5%) had no treatment prior to KT. Cinacalcet use increased throughout the duration of the study period with 18.4% of patients receiving it 2007 versus 46.2% in 2017(p<0.001). Utilization of parathyroidectomy increased from 0.8% in 2007 to 3.1% in 2016(p=0.005). Compared to patients treated with cinacalcet, those treated with parathyroidectomy had a lower risk of developing tertiary hyperparathyroidism(aHR=0.49,95%CI:0.29-0.82) at 3 years post-KT and those who received no treatment had lower odds of delayed graft function(aOR=0.87,95%CI:0.78-0.96). There was no association between treatment of SHPTH and post-transplant death-censored graft failure, all-cause graft failure or death.

Conclusion

The use of calcimimetics and parathyroidectomy to treat SHPTH has been steadily increasing since 2007. Importantly, patients who underwent parathyroidectomy for SHPTH had lower risk of developing tertiary hyperparathyroidism post-transplant. Therefore, patients treated with cinacalcet pre-transplant may need closer surveillance post-transplant for development of tertiary hyperparathyroidism.

Funding

  • Other NIH Support