Treatment strategy of end stage renal disease-related hyperparathyroidism before, during, and after the era of calcimimetics

• Published in: Surgery Vol. 165; no. 1; pp. 135 - 141
• Main Authors: van der Plas, Willemijn Y., Engelsman, Anton F., Umakanthan, Marille, Mather, Amanda, Sidhu, Stan B., Delbridge, Leigh W., Pollock, Carol, Waugh, David, Sywak, Mark S., Kruijff, Schelto
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-01-2019
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2018.04.092

Since 2004, end-stage renal disease related hyperparathyroidism patients are treated mainly with cinacalcet, which ceased to be subsidized through the Australian Pharmaceutical Benefits Scheme in 2015. We aimed to investigate the impact of these changes on the treatment strategy in the Australian end-stage renal disease population.
The following groups were formed according to the date of parathyroidectomy: A, before calcimimetics; B, during the era of calcimimetics; and C, after cinacalcet removal by the Australian Pharmaceutical Benefits Scheme. The primary outcome was time from start of dialysis to parathyroidectomy. Regression analysis was used to examine trends in parathyroidectomy rates.
Between 1998 and 2016, 195 parathyroidectomies were performed. Median time to referral was 69 (33–123), 67 (31–110) and 44 (23–102) months for groups A, B, and C, respectively (P = .55). Parathyroidectomy rates increased throughout the years (CI 0.09–1.13, R2=0.27, P = .02). A trend toward a dip in parathyroidectomy rates was seen during the era of cinacalcet (P = .08). Median preoperative parathyroid hormone levels increased significantly (842 [418–1,553] versus 1,040 [564–1,810] versus 1,350 [1,037–1,923] pg/mL, for groups A, B, and C, respectively [P < .01]).
Parathyroidectomy rates seem to vary according to the availability of cinacalcet. This change in treatment strategy is accompanied with increased preoperative parathyroid hormone levels, reflecting delayed surgery and increased disease severity.