Comparative effectiveness of parathyroidectomy versus cinacalcet in severe secondary hyperparathyroidism among hemodialysis patients in Sudan: a retrospective cohort study.

BACKGROUND

Severe secondary hyperparathyroidism (SHPT) is a frequent consequence of long-term hemodialysis and remains a major management challenge in resource-limited settings. The comparative benefit of surgical parathyroidectomy (PTx) and medical therapy with the calcimimetic cinacalcet is still debated, particularly where access and adherence barriers exist.

METHODS

A retrospective cohort analysis was conducted at Baraha Medical City, Sudan, including adults on maintenance hemodialysis with severe SHPT (intact parathyroid hormone (iPTH) ≥ 800 pg/mL) treated between 2018 and 2022. Participants received either PTx (n = 41) or cinacalcet (n = 68). The principal endpoint was biochemical improvement within 3–6 months, defined as iPTH < 600 pg/mL or ≥ 30% reduction from baseline. Secondary outcomes included symptomatic relief, correction of serum calcium and phosphate, treatment adherence, complications, and one-year mortality.

RESULTS

A biochemical response was achieved in over 90% of surgical patients compared with 47.1% of those treated with cinacalcet (p < 0.001). At 3–6 months, symptom improvement was noted in 75% of the PTx group versus 54% of the cinacalcet group (p = 0.04). Surgery also resulted in higher normalization rates for calcium and phosphate. At one-year, sustained symptom control persisted in 90.2% of surgical patients versus 29.4% with cinacalcet (p < 0.001). Hospitalizations and mortality were numerically lower after PTx, though not statistically significant. High adherence to cinacalcet was observed in only 27.9%, with discontinuation mainly due to financial or supply limitations.

CONCLUSIONS

PTx produced superior biochemical and clinical outcomes compared with cinacalcet, although the impact of calcimimetic therapy was hindered by restricted availability and suboptimal adherence. Extended follow-up is needed to evaluate long-term skeletal and cardiovascular effects and explore delivery models that improve treatment continuity. CLINICAL TRIAL REGISTRATION: This was a retrospective observational cohort study and not a prospective interventional clinical trial; therefore, trial registration was not applicable.