Treating secondary hyperparathyroidism (SHPT) may lower dementia risk in older patients with end-stage kidney disease (ESKD), researchers reported at the American Society of Nephrology’s Kidney Week 2021.

According to US Renal Data System and Medicare claims data, 189,433 patients 66 years and older initiated maintenance dialysis in 2006-2016. Of these, 65.1% received at least 1 treatment to lower parathyroid hormone levels, such as vitamin D analogs, phosphate binders, cinacalcet, or parathyroidectomy. All patients were free of dementia at baseline.

During the follow-up period, incident dementia occurred at a lower rate among patients receiving vs not receiving SHPT treatment: 6 vs 11 per 100 person-years, Aarti Mathur MD, PhD, and colleagues from The Johns Hopkins University School of Medicine in Baltimore, Maryland, reported. Treated patients had a significant 42% reduced risk for dementia after adjustment for potential confounders. The lowest risks were observed in women and Black and Asian patients.


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“SHPT may need to be controlled among older ESKD patients considering the complications of SHPT include cognitive impairment and dementia,” Dr Mathur said in an interview with Renal & Urology News. “Our work provides additional support for treatment of SHPT. KDIGO guidelines recommend maintaining parathyroid hormone levels in between 2 to 9 times the upper limit of normal.”

The study lacked data on parathyroid hormone levels before and after treatment, which is a limitation.

A previous meta-analysis on the topic suggested that abnormal parathyroid hormone levels play a role in neuronal calcium dysregulation, hypoperfusion and disrupted neuronal signaling.

References

Ahn JB, Mathur A, Segev DL, McAdams-DeMarco M. Patients who are treated for secondary hyperparathyroidism have a lower risk of incident dementia. Presented at: Kidney Week 2021; November 2-7, 2021. Abstract: PO1385.

Lourida I, Thompson-Coon J, Dickens CM, Soni M, Kuźma E, Kos K, Llewellyn DJ. Parathyroid hormone, cognitive function and dementia: a systematic review. PLoS One. 2015 May 26;10(5):e0127574. doi:10.1371/journal.pone.0127574