Treating secondary hyperparathyroidism (SHPT) proactively rather than reactively may decrease the risk of adverse outcomes in patients on hemodialysis, according to new research presented at the American Society of Nephrology’s Kidney Week 2022 conference in Orlando, Florida.
Using observational data, investigators emulated randomized controlled trials of different parathyroid hormone (PTH) targets (Trial 1) and different SHPT agents (Trial 2). Trial 1 included 635 patients with new onset SHPT from 2009 to 2014 who received proactive treatment (defined as uptitration of SHPT agents to attain lower PTH) and 517 patients who received reactive treatment (no uptitration). Trial 2 included 3001 patients yielding 6268 vitamin D-favoring cases and 459 cinacalcet-favoring cases.
A proactive vs reactive treatment approach was significantly associated with a 29% lower risk for all-cause mortality, a 22% lower risk for cardiovascular hospitalization, and a 26% lower risk for a composite of these outcomes, Julia J. Scialla, MD, MHS, of the University of Virginia, Charlottesville, reported for her team.
A treatment approach favoring cinacalcet vs vitamin D was significantly associated with a 21% lower risk of all-cause mortality, but not cardiovascular hospitalization or the composite outcome.
“Proactive SHPT care is associated with better outcomes,” Dr Scialla’s team concluded. A randomized controlled trial of lower vs higher PTH targets to prevent death and cardiovascular disease in patients with SHPT is justified, they wrote.
Platt AC, Wilson JA, Hall RK, et al. Comparative effectiveness of alternative treatment approaches to secondary hyperparathyroidism (SHPT) in patients on maintenance hemodialysis (HD). Presented at: Kidney Week 2022; November 3-6, Orlando, Florida. Abstract TH-PO153.