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American Journal of Kidney Diseases

Parathyroidectomy and Cinacalcet Use in Medicare-Insured Kidney Transplant Recipients

Published:September 23, 2022DOI:https://doi.org/10.1053/j.ajkd.2022.07.015

      Abstract

      Rationale & Objective

      Post-transplant hyperparathyroidism is common and treatment practices are poorly characterized. The goal of this study was to examine the incidence, associations, and outcomes of post-transplant parathyroidectomy and calcimimetic use in a cohort of Medicare-insured US kidney transplant recipients.

      Study Design

      Retrospective observational cohort study.

      Setting & Participants

      We used the US Renal Data System to extract demographic, clinical, and prescription data from Medicare Parts A, B and D-insured patients who received their first kidney transplant between 2007 and 2013. We excluded patients with pre-transplant parathyroidectomy.

      Predictors

      Calendar year of transplantation and pre-transplant patient characteristics.

      Outcomes

      1) Incidence of and secular trends in parathyroidectomy and cinacalcet use in the 3 years following transplant, 2) 90-day outcomes following post-transplant parathyroidectomy and cinacalcet initiation.

      Analytical Approach

      Temporal trends and pre-transplant correlates of parathyroidectomy and cinacalcet use were assessed using proportional hazards models and multivariable Poisson regression, respectively.

      Results

      30,127 patients met the inclusion criteria. 10,707 used cinacalcet pre-transplant. 551 patients underwent post-transplant parathyroidectomy and 5413 patients filled ≥ 1 prescription for cinacalcet. The rate of post-transplant parathyroidectomy was stable over time. In contrast, cinacalcet use increased during the period studied. Long dialysis vintage and pre-transplant cinacalcet use were strongly associated with post-transplant parathyroidectomy and cinacalcet use. Roughly one in four patients were hospitalized within 90 days of post-transplant parathyroidectomy, with hypocalcemia-related diagnoses being the most common complication. Parathyroidectomy (versus cinacalcet initiation) was not associated with an increase in acute kidney injury.

      Limitations

      We lacked access to laboratory data to help assess severity of secondary/tertiary hyperparathyroidism. The cohort was limited to Medicare beneficiaries.

      Conclusions

      Almost one fifth of our study cohort was treated with parathyroidectomy and/or cinacalcet. Further studies are needed to establish the optimal treatment for post-transplant hyperparathyroidism.
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      Linked Article

      • Persistent Hyperparathyroidism: A Reality Calling for Additional Evidence
        American Journal of Kidney Diseases
        • Preview
          In this issue of AJKD, Wang et al1 report on the incidence, trends, and consequences of treatment of posttransplant hyperparathyroidism in a nationwide registry encompassing 30,127 Medicare-insured US patients who received a first kidney transplant. The 2 treatments of interest were cinacalcet use and parathyroidectomy in the first 3 years following kidney transplantation. The authors report that cinacalcet use was common (18%) and increased by 20% from 2007 to 2013, with treatment most often initiated early in the posttransplant course (a median of 6.8 weeks).
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