Abstract: FR-PO0252
Increased Mortality Rate with Cinacalcet vs. Parathyroidectomy in Patients with Secondary Hyperparathyroidism: Systematic Review and Meta-Analysis
Session Information
- Bone and Mineral Metabolism: Clinical Epidemiology and Outcomes
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Bone and Mineral Metabolism
- 502 Bone and Mineral Metabolism: Clinical
Authors
- Leesutipornchai, Thiratest, Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Tanariyakul, Manasawee, University of Hawai'i at Manoa, Honolulu, Hawaii, United States
- Ratchataswan, Thanaporn, Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Aiumtrakul, Noppawit, University of Hawai'i at Manoa, Honolulu, Hawaii, United States
Background
Secondary hyperparathyroidism (SHPT) is a significant complication in end-stage renal disease. Parathyroidectomy (PTX) is the standard treatment, but cinacalcet has emerged as a noninvasive alternative. However, comparative evidence on the outcomes of these interventions remains limited. This systematic review and meta-analysis aimed to evaluate the major outcomes of cinacalcet versus PTX in SHPT patients.
Methods
We conducted a thorough search of MEDLINE, EMBASE, and the Cochrane Library up to January 2025. Included studies were RCT and cohort studies assessing outcomes such as mortality, cardiovascular events, fractures, and persistent hypocalcemia rates in patients treated with cinacalcet versus PTX for SHPT. We used random-effects models to calculate risk ratios (RR) and 95% confidence intervals (CIs).
Results
One RCT and eight cohort studies were included in the analysis with a total of 13,315 SHPT patients (9930 patients with cinacalcet group and 3385 patients with PTX group). Cinacalcet group had an increased mortality rate (pooled RR 1.16, 95%CI:1.04–1.30, p=0.01, I2=23.6%) compared to PTX group. No significant difference was found between the two groups for cardiovascular events (pooled RR 1.09, 95% CI: 0.86–1.38, p=0.49, I2=37.5%), fractures (pooled RR 0.91, 95% CI: 0.82–1.00, p=0.05, I2=0.0%), or persistent hypocalcemia (pooled RR 0.40, 95% CI: 0.11–1.53, p=0.08, I2=0.0%).
Conclusion
Our meta-analysis indicates that cinacalcet is associated with a higher mortality rate in SHPT patients compared to PTX. No significant differences were observed between the two treatments for other outcomes, including cardiovascular events, fractures, or persistent hypocalcemia. These findings suggest that while cinacalcet may be a viable alternative, PTX remains the preferred treatment due to its association with lower mortality rates in SHPT patients