Expanding Outcomes Beyond Chronic Kidney Disease-Mineral and Bone Disorder: A Propensity Score-Matched Analysis of Parathyroidectomy versus Calcimimetics in Dialysis Patients with Secondary Hyperparathyroidism.

BACKGROUND

Secondary hyperparathyroidism (SHPT) is a common complication in patients with end-stage renal disease (ESRD) receiving dialysis. Although calcimimetics (CAMs) and parathyroidectomy (PTx) are widely used for severe SHPT, their comparative effects on long-term clinical outcomes beyond mineral and bone disorder remain uncertain.

METHODS

We conducted a retrospective multicenter cohort study using the TriNetX research network (2010-2024). Adult dialysis patients with ESRD and severe SHPT, defined by at least one historical intact parathyroid hormone level >600 pg/mL prior to treatment initiation, were included. Patients receiving both therapies were excluded. After 1:1 propensity score matching for demographics, comorbidities, medications, and laboratory variables, outcomes including all-cause mortality, major adverse cardiovascular events (MACE), fracture, cognitive impairment, mild cognitive impairment (MCI), and sepsis were compared using Cox proportional hazards models.

RESULTS

After propensity score matching, 22,580 patients were included (11,290 in each group), with follow-up extending to 7 years. Compared with CAM therapy, PTx was associated with significantly lower risks of all-cause mortality (hazard ratio [HR] 0.914, 95% confidence interval [CI] 0.860-0.972), mild cognitive impairment (HR 0.646, 95% CI 0.436-0.955), and sepsis (HR 0.844, 95% CI 0.765-0.930). No significant differences were observed for MACE, fracture, hungry bone disease, overall cognitive impairment, or malignancy.

CONCLUSION

In patients with ESRD and severe SHPT, parathyroidectomy was associated with lower risks of mortality, mild cognitive impairment, and sepsis compared with calcimimetic therapy, while cardiovascular and fracture outcomes were comparable. These findings suggest that PTx may confer broader systemic benefits beyond mineral and bone disorder control in selected dialysis patients.