Surgery · 2025
Parathyroidectomy is associated with lower mortality and fewer cardiac complications in patients with secondary hyperparathyroidism.
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Song Zhixing, Kasmirski Julia, Balachandra Sanjana, Wu Christopher, Gillis Andrea, Fazendin Jessica, Lindeman Brenessa, Chen Herbert
Аннотация
BACKGROUND: Secondary hyperparathyroidism can be treated with calcimimetics such as cinacalcet or surgically with parathyroidectomy. The adoption of cinacalcet has reduced the frequency of surgical management. This study evaluates the long-term outcomes of parathyroidectomy versus cinacalcet in patients with renal-origin secondary hyperparathyroidism who previously received conventional therapy.
METHODS: We conducted a retrospective analysis using electronic health records (2004-2025) from the TriNetX platform. Patients with renal-origin secondary hyperparathyroidism and a medication history of vitamin D or phosphate binders were included. Those treated with cinacalcet for ≥6 months were compared to those who underwent parathyroidectomy without cinacalcet use or kidney transplantation. Propensity score matching (1:1) controlled for demographics, comorbidities, and cardiovascular therapies. Cox proportional hazards models estimated hazard ratios and 95% confidence intervals for mortality and cardiac outcomes.
RESULTS: Among 11,581 patients, 1,478 (12.8%) underwent parathyroidectomy and 10,103 (87.2%) received cinacalcet. After matching, 1,227 patients were included in each group. Over a median follow-up of 4 years, parathyroidectomy was associated with lower risks of mortality (hazard ratio 0.68, 95% confidence interval 0.58-0.80) and composite cardiac events (0.75, 0.64-0.87). It was also associated with lower risks of ischemic heart disease, heart failure, and arrhythmias. Among patients with parathyroid hormone ≤585 pg/mL, parathyroidectomy remained associated with lower mortality (hazard ratio 0.73, 95% confidence interval 0.59-0.90) and cardiac risk (0.62, 0.50-0.77).
CONCLUSIONS: Parathyroidectomy may provide superior long-term survival and cardiovascular outcomes compared to cinacalcet, even in patients with moderately elevated parathyroid hormone.
METHODS: We conducted a retrospective analysis using electronic health records (2004-2025) from the TriNetX platform. Patients with renal-origin secondary hyperparathyroidism and a medication history of vitamin D or phosphate binders were included. Those treated with cinacalcet for ≥6 months were compared to those who underwent parathyroidectomy without cinacalcet use or kidney transplantation. Propensity score matching (1:1) controlled for demographics, comorbidities, and cardiovascular therapies. Cox proportional hazards models estimated hazard ratios and 95% confidence intervals for mortality and cardiac outcomes.
RESULTS: Among 11,581 patients, 1,478 (12.8%) underwent parathyroidectomy and 10,103 (87.2%) received cinacalcet. After matching, 1,227 patients were included in each group. Over a median follow-up of 4 years, parathyroidectomy was associated with lower risks of mortality (hazard ratio 0.68, 95% confidence interval 0.58-0.80) and composite cardiac events (0.75, 0.64-0.87). It was also associated with lower risks of ischemic heart disease, heart failure, and arrhythmias. Among patients with parathyroid hormone ≤585 pg/mL, parathyroidectomy remained associated with lower mortality (hazard ratio 0.73, 95% confidence interval 0.59-0.90) and cardiac risk (0.62, 0.50-0.77).
CONCLUSIONS: Parathyroidectomy may provide superior long-term survival and cardiovascular outcomes compared to cinacalcet, even in patients with moderately elevated parathyroid hormone.