Younger age, black race, and longer dialysis vintage are among the factors that increase a hemodialysis (HD) patient’s likelihood of undergoing a parathyroidectomy for secondary hyperparathyroidism, according to a study presented at the National Kidney Foundation’s 2014 Spring Clinical Meetings in Las Vegas.
The study, led by James B. Wetmore, MD, MS, of the Chronic Disease Research Group, Minneapolis Medical Research Foundation, compared 4,435 adult HD patients who underwent a parathyroidectomy and 315,312 who did not. HD patients aged 19-44 years were twice as likely to have a parathyroidectomy as those aged 45-64 years (reference). Black patients were 29% more likely than whites (reference) to have the surgery.
Compared with patients who had a dialysis vintage of at least 1 year but less than 3 years (reference), those with a dialysis vintage of 5 years or more had a greater than 3-fold increased odds of undergoing a parathyroidectomy. Patients with a dialysis vintage of at least 3 years but less than 5 years had an approximately 2-fold increased likelihood of having the operation.
The study demonstrated that the surgery was more likely to performed on patients with a higher body mass index and atherosclerotic and other heart disease.
Additionally, the researchers found a roughly 2-fold diffrence in the use of parathyroidectomy, even after adjusting for other factors, by end-stage renal disease network. “Thus, some regions of the country seem much more likely to offer parathyroidectomy than others,” Dr. Wetmore told Renal & Urology News. “We cannot, at this time, say which approach is optimal for patients, but this fairly wide range in parathyroidectomy rates suggest there are differences in the nephrology community about its role in the care of secondary hyperparathyroidism.”
With respect to study limitations, Dr. Wetmore’s group noted that they did not have information on laboratory values and medication use, both of which would be expected to influence the likelihood of parathyroidectomy.