WASHINGTON—Parathyroidectomy (PTx) may offer a survival advantage compared with cinacalcet in patients with secondary hyperparathyroidism (SHPT), according to new study findings presented at the American Society of Nephrology’s Kidney Week 2019 meeting.

Using the Japanese Society for Dialysis Therapy (2007-2015) Renal Data Registry, Hirotaka Komaba, MD, PhD, of Tokai University in Japan, and colleagues identified 9183 patients on hemodialysis patients who met enrollment criteria: intact parathyroid hormone (iPTH) levels exceeding 300 pg/mL and no history of prior PTx at the end of 2007. The investigators matched 894 PTx patients to 2682 cinacalcet patients (mean age 58 years; 45% female) by propensity score. During 6 years of follow-up, 201 PTx and 736 cinacalcet patients died.

PTx was associated with a significant 22% lower risk for all-cause mortality than cinacalcet in unadjusted analyses, but this declined to a nonsignificant 10% lower death risk after adjustment for time-varying iPTH, serum calcium, and serum phosphorus levels, Dr Komaba’s team reported. Patients with severe SHPT (iPTH of 500 pg/mL or higher at baseline) and baseline serum calcium levels exceeding 10.0 mg/dL experienced the greatest survival benefit after surgery.

Overall, iPTH fell to lower levels after PTx than cinacalcet. Serum calcium and phosphorus were slightly higher with cinacalcet.

“Our results suggest that PTx might be superior to cinacalcet in improving survival in hemodialysis patients with severe secondary hyperparathyroidism, but additional studies are needed to confirm our findings,” Dr Komaba told Renal & Urology News. “Until more definitive evidence is available, the decision to use PTx should be made on a case-by-case basis.”

Reference

Komaba H, Hamano T, Fujii N, et al. Parathyroidectomy vs. cinacalcet for secondary hyperparathyroidism in patients undergoing hemodialysis. Presented at the American Society of Nephrology’s Kidney Week 2019 meeting held November 5-10, 2019 in Washington DC. Poster FR-PO129.