A Retrospective Comparison of Treatment Options in Secondary Hyperparathyroidism on Calcium Metabolism: A Single Center Study

Treatment of Secondary Hyperparathyroidism

Abstract

Background: Many patients on hemodialysis (HD) receive treatment for secondary hyperparathyroidism (sHPT), but few studies have assessed the clinical outcomes for these patients when treated with cinacalcet or parathyroidectomy (PTx). This study aimed to compare the short-term outcomes of cinacalcet and PTx in HD patients with sHPT.

Methods: The study included retrospective data from 52 patients with ESRD who underwent HD and were diagnosed with sHPT between 2001 and 2013. Data regarding participant age, gender, serum calcium (mg/dL), phosphorus (mg/dL), and parathormone (PTH, pg/mL) levels before and six months after treatment initiation (after surgery for patients who underwent PTx) were obtained from patient files.

Results: The study involved 12 patients who underwent PTx, 18 patients treated with cinacalcet, and 22 who received calcitriol. PTx was the only treatment that significantly reduced post-treatment calcium. The mean calcium levels of patients treated with PTx were 7.67±0.95 mg/dL, showing a mean difference of 1.2 mg/dL (p=0.005, paired-samples t-test). Both PTx and cinacalcet significantly reduced phosphorus levels, when compared in mean changes, patients who underwent PTx had higher median reductions in phosphorus concentrations compared to patients treated with cinacalcet (p=0.03, Mann-Whitney U test). Post-treatment PTH levels significantly decreased in both the PTx and cinacalcet groups, however, only the patients who underwent PTx achieved PTH levels within the recommended range; post-treatment PTH levels in the cinacalcet group remained higher than recommended levels.

Conclusion: Both PTx and cinacalcet are beneficial in managing sHPT, however, PTx provides more significant improvements in mineral metabolism, while cinacalcet offers a less invasive alternative as a medical treatment.