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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 1/2017

Open Access 01-01-2017 | Healthcare Policy and Outcomes

Impact of the Introduction of Calcimimetics on Timing of Parathyroidectomy in Secondary and Tertiary Hyperparathyroidism

Authors: Willemijn Y. van der Plas, BSc, Anton F. Engelsman, MD, Akin Özyilmaz, MD, Anouk N. van der Horst-Schrivers, MD, PhD, Kornelis Meijer, MD, PhD, Gooitzen M. van Dam, MD, PhD, Robert A. Pol, MD, PhD, Martin H. de Borst, MD, PhD, Schelto Kruijff, MD, PhD

Published in: Annals of Surgical Oncology | Issue 1/2017

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Abstract

Background

Hyperparathyroidism (HPT), both secondary and tertiary, is common in patients with end-stage renal disease, and is associated with severe bone disorders, cardiovascular complications, and increased mortality. Since the introduction of calcimimetics in 2004, treatment of HPT has shifted from surgery to predominantly medical therapy.

Objective

The aim of this study was to evaluate the impact of this change of management on the HPT patient population before undergoing (sub-)total parathyroidectomy (PTx).

Methods

Overall, 119 patients with secondary or tertiary HPT undergoing PTx were included in a retrospective, single-center cohort. Group A, who underwent PTx before January 2005, was compared with group B, who underwent PTx after January 2005. Patient characteristics, time interval between HPT diagnosis and PTx, and postoperative complications were compared.

Results

Group A comprised 70 (58.8 %) patients and group B comprised 49 (41.2 %) patients. The median interval between HPT diagnosis and PTx was 27 (interquartile range [IQR] 12.5–48.0) and 49 (IQR 21.0–75.0) months for group A and B, respectively (p = 0.007). Baseline characteristics were similar among both groups. The median preoperative serum parathyroid hormone (PTH) level was 936 pg/mL (IQR 600–1273) for group A versus 1091 pg/mL (IQR 482–1373) for group B (p = 0.38). PTx resulted in a dramatic PTH reduction (less than twofold the upper limit: A, 80.0 %; B, 85.4 %), and postoperative complication rates were low in both groups (A: 7.8 %; B: 10.2 %) [p = 0.66].

Conclusions

The introduction of calcimimetics in 2004 is associated with a significant 2-year delay of surgery with continuously elevated preoperative PTH levels, while parathyroid surgery, even in a fragile population, is considered a safe and effective procedure.
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Metadata
Title
Impact of the Introduction of Calcimimetics on Timing of Parathyroidectomy in Secondary and Tertiary Hyperparathyroidism
Authors
Willemijn Y. van der Plas, BSc
Anton F. Engelsman, MD
Akin Özyilmaz, MD
Anouk N. van der Horst-Schrivers, MD, PhD
Kornelis Meijer, MD, PhD
Gooitzen M. van Dam, MD, PhD
Robert A. Pol, MD, PhD
Martin H. de Borst, MD, PhD
Schelto Kruijff, MD, PhD
Publication date
01-01-2017
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 1/2017
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-016-5450-6

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