Assessment of Cardiovascular Risks by CT-Derived Calcium Scoring and FGF-23 in Patients with Renal Hyperparathyroidism Undergoing Near-Total Parathyroidectomy and Cinacalcet Therapy: A Prospective Pilot Study.

INTRODUCTION: Near-total parathyroidectomy (NPTX) could provide persistent improvements in dysregulated mineral metabolism, leading to a reduction in all-cause and cardiovascular (CV) mortality by reducing coronary artery calcium score (CACS) in refractory secondary hyperparathyroidism (SHPT). In this study, we have attempted to compare the effect of NPTX and cinacalcet therapy in patients with refractory SHPT on dialysis, with regard to their effects on CACS and FGF-23.

METHODS: A total of 14 patients with refractory SHPT were followed prospectively. Five patients were enrolled in the NPTX arm and nine in the cinacalcet arm. Demographics, CACS, biochemical, and hormonal analysis were performed at baseline with a planned follow-up of 1 year.

RESULTS: The NPTX group showed a more favourable change in total calcification score over 1 year compared to the cinacalcet group, with a mean difference of 625.6 units. After NPTX, CACS was stable or reduced (<15% per year increase in CACS) in four of five (80%) patients. In the cinacalcet group, for those with a very severe baseline CACS (>400), there was a progression in the CACS. In the NPTX group, iPTH and FGF 23 reduced significantly after 1 year with an iPTH of 58.00 (8.5-76) pg/mL (P < 0.001) and FGF 23 of 5.4 (5.4-7.9) pg/mL (P < 0.04), respectively.

CONCLUSION: NTPTX resulted in amelioration of dysregulated mineral metabolism, leading to reduction or stabilization of CACS. There was also a marked reduction in FGF-23 levels following NPTX, which may be the principal factor in preventing the progression of CACS.