Q. TAO1, Z. Ji1, Z. Zhu1, R. Tang2, B. Liu2 1Affiliated Zhongda Hospital, Southeast University Medical School,General Surgery,Nanjing, JIANGSU, China 2Affiliated Zhongda Hospital, Southeast University Medical School,Nephrology,Nanjing, JIANGSU, China
Introduction: In this prospective cohort study, efficacy and safety of parathyroidectomy (PTX) were compared with that of cinacalcet-centred therapy (CCT) for the treatment of chronic kidney disease (CKD)-associated secondary hyperparathyroidism (SHPT) in end-stage renal disease (ESRD).
Methods: Adult patients with Stage 5 CKD between Feberary 2012 and December 2013 at our institution who met the indications for PTX, with an intact parathyroid hormone (iPTH) level ≥ 1000pg/ml associated with hypercalcemia and/or hyperphosphatemia for at least 50% of that period, were included. Baseline characteristics and iPTH, calcium, phosphorus and alkaline phosphatase (ALP) at baseline, 3 and 6 months were compared between the two groups (PTX versus CCT) using the χ2 and paired t-tests.
Results: Of the total population of 112 patients who satisfied KDOQI criteria for PTX, only 34 (30.4%) received PTX, the others received CCT. At baseline, PTX patients had higher iPTH (P=0.011) and ALP (P=0.027). Complete follow-up data at 3 months were available on 85 patients (PTX = 27; CCT =58). PTX had significantly reduction in iPTH (92 versus 56%) compared with CCT. A greater proportion of patients receiving PTX achieved target iPTH levels throughout the study compared with the patients receiving CCT (P=0.002 after 3 months; P=0.013 after 6 months). Changes from baseline in calcium and phosphate levels and proportion of patients achieving target values of bone markers were not significant for either intervention. Findings were consistent at 6 months.
Conclusion: PTX can reduce iPTH levels more than CCT in the patients who met indications for PTX. No significant difference in circulating bone markers reductions were found between these two groups.