Untreated SHPT Increases Mortality Risk

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PHILADELPHIA—Untreated secondary hyperparathyroidism (SHPT) is associated with increased mortality risk in hemodialysis (HD) patients, according to a report presented at Kidney Week 2011.

Compared with HD patients with parathyroid hormone (PTH) levels of 150-299 pg/mL (reference), those with levels of 500 pg/mL or higher had a significant 33% increased death risk after adjusting for potential confounders.

Francesca Tentori, MD, of Arbor Research Collaborative for Health in Ann Arbor, Mich., and colleagues analyzed data from 17,476 participants in the Dialysis Outcomes and practice Patterns Study (DOPPS). Of these, 5,728 subjects had no evidence of treatment for SHPT (no vitamin D or cinacalcet prescription for 12 months following study entry). The investigators used the most recent PTH value at the end of the 12-study period to examine the association between PTH levels and mortality.

The study also showed that patients with PTH levels below 50 pg/mL had a significant 29% increased death risk.

Compared with subjects receiving SHPT therapy, untreated patients had shorter duration of HD and lower serum PTH (mean 217.0 vs. 306.9 pg/mL).

Dr. Tentori's group concluded that their findings indicate an opportunity for improvement in clinical practice because a high proportion of untreated patients had PTH levels above the lowest risk range.

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