Underutilization of parathyroidectomy among dialysis patients with tertiary hyperparathyroidism

Tertiary hyperparathyroidism (THPT) is often diagnosed post-kidney transplant (KT); Parathyroidectomy is curative. Pre-KT THPT increases post-KT THPT risk; however, epidemiology among dialysis patients remains unknown. We examined THPT prevalence, risk factors, and treatment among dialysis patients.

We identified THPT patients using the United States Dialysis Outcomes and Practice Patterns Study phases 4-7, defining THPT as multiple calcium levels>10 mg/dL with PTH≥70 pg/mL. We identified THPT and calcimimetic treatment risk factors using adjusted multivariable logistic regression.

Out of 79,624 patients, 442(0.6%) had THPT. Compared to non-THPT patients, THPT patients were frequently Black (45.3%vs36.4%), on dialysis>5 years (36.7%vs22.6%), and receiving calcimimetics (48.6%vs29.2%)(p < 0.001); parathyroidectomy was underutilized in both groups (0%vs0.7%). THPT risk factors included dialysis>5 years (aOR1.43,95%CI:1.10-1.83) and PTH>300(aOR1.87,95%CI:1.36-2.56). Calcimimetic risk factors included vitamin D use (aOR1.31,95%CI:1.39-8.13),>5 dialysis years (aOR2.56,95%CI:1.57-7.63) and PTH>300(aOR3.37,95%CI:1.57-7.62).

THPT is rare and frequently managed with calcimimetics among dialysis patients. Guidelines are needed to ensure earlier parathyroidectomy.