Parathyroidectomy (PTx) rates for secondary hyperparathyroidism (SHPT) have dropped dramatically over the last decade for unknown reasons, a new study finds.
From 2004 to 2016, PTx rates for SHPT decreased from 6.07 to 3.67 per 1000 patients with end-stage kidney disease (ESKD), Benjamin C. James, MD, MS, of Beth Israel Deaconess Medical Center in Boston, Massachusetts, and colleagues reported in the Journal of Surgical Research. Black patients underwent PTx at a 1.8-fold higher rate than White and Hispanic patients (5.6 vs 3.0 and 3.1, respectively), they found. Previous studies have found that Black patients have higher parathyroid gland mass and serum parathyroid hormone, according to the investigators, and this may suggest longer time to referral or inadequate medical management.
In-hospital mortality after PTx decreased nonsignificantly from 1.5% to 0.7% during the study period. Weight loss/malnutrition and cardiac arrhythmia were significantly associated with 4.2- and 3.4-fold increased odds for inpatient death. In a fully adjusted model, Elixhauser Comorbidity Index was significantly associated with 1.5-fold increased odds for inpatient death for each additional comorbidity, such as lung disease, liver disease, and hypertension. Obesity was significantly associated with 77% decreased odds for in-hospital death.
“The etiology of the declining parathyroidectomy rate for SHPT is unclear,” Dr James’ team stated. They suggested changing guidelines emphasizing medical management, widespread availability of cinacalcet, changing practice patterns, and inadequate surgical referral as possible contributors to the downtrend.
The 2017 Kidney Disease: Improving Global Outcomes (KDIGO) practice guideline update recommended PTx for patients who have stage 3-5D chronic kidney disease accompanied by severe SHPT refractory to medical therapy. Other indications for PTx include refractory pruritus, bone pain, weakness, and calciphylaxis.
Fligor SC, Li C, Hamaguchi R, William J, James BC. Decreasing surgical management of secondary hyperparathyroidism in the United States. J Surg Res. 2021;264:444-453. doi:10.1016/j.jss.2021.03.013