Patients who receive parathyroidectomy (PTx) rather than cinacalcet for secondary hyperparathyroidism (SHPT) have a lower risk of developing tertiary hyperparathyroidism after receiving a kidney transplant, researchers reported at Kidney Week 2020 Reimagined, the virtual meeting of the American Society of Nephrology. 

PTx significantly reduced the risk for tertiary hyperparathyroidism by 51% at 3 years compared with the calcimimetic cinacalcet after adjustments for pre- and perioperative transplant factors, Aarti Mathur, MD, of Johns Hopkins University in Baltimore, Maryland, and colleagues reported. Having no SHPT treatment was associated with a significant 59% lower risk of tertiary hyperparathyroidism.

“Therefore, transplant nephrologists should consider parathyroidectomy for patients with SHPT or monitor patients who received cinacalcet more closely,” Dr Mathur’s team stated.

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Their findings were based on data from 12,372 patients on dialysis with SHPT from the Scientific Registry of Transplant Recipients and Medicare claims. Of the cohort, 4554 (36.8%) received cinacalcet, 205 (1.7%) underwent PTx, and 7613 (61.5%) had no SHPT treatment prior to kidney transplant. Annual cinacalcet use increased significantly  from 18.4% of patients in 2007 to 46.2% in 2016. Likewise, PTx use significantly increased from 0.8% to 3.1% of patients during the same period. There was no association between SHPT treatment and post-transplant graft failure or death.


Mathur A, Sutton W; Ahn YB, Segev DL, McAdams-DeMarco M. Trends in treatment of secondary hyperparathyroidism and association with post-transplant outcomes. Presented at: Kidney Week 2020 Reimagined, October 19-25, 2020. Poster PO0419.