Treatment strategy of end stage renal disease-related hyperparathyroidism before, during, and after the era of calcimimetics.
Adult
Aged
Australia
Calcimimetic Agents
/ therapeutic use
Cinacalcet
/ therapeutic use
Female
Humans
Hyperparathyroidism, Secondary
/ etiology
Insurance, Pharmaceutical Services
Kidney Failure, Chronic
/ complications
Male
Middle Aged
Parathyroid Hormone
/ blood
Parathyroidectomy
/ statistics & numerical data
Regression Analysis
Severity of Illness Index
Time-to-Treatment
Journal
Surgery
ISSN: 1532-7361
Titre abrégé: Surgery
Pays: United States
ID NLM: 0417347
Informations de publication
Date de publication:
01 2019
01 2019
Historique:
received:
31
01
2018
revised:
03
04
2018
accepted:
07
04
2018
pubmed:
11
11
2018
medline:
15
10
2019
entrez:
11
11
2018
Statut:
ppublish
Résumé
Since 2004, end-stage renal disease related hyperparathyroidism patients are treated mainly with cinacalcet, which ceased to be subsidized through the Australian Pharmaceutical Benefits Scheme in 2015. We aimed to investigate the impact of these changes on the treatment strategy in the Australian end-stage renal disease population. The following groups were formed according to the date of parathyroidectomy: A, before calcimimetics; B, during the era of calcimimetics; and C, after cinacalcet removal by the Australian Pharmaceutical Benefits Scheme. The primary outcome was time from start of dialysis to parathyroidectomy. Regression analysis was used to examine trends in parathyroidectomy rates. Between 1998 and 2016, 195 parathyroidectomies were performed. Median time to referral was 69 (33-123), 67 (31-110) and 44 (23-102) months for groups A, B, and C, respectively (P = .55). Parathyroidectomy rates increased throughout the years (CI 0.09-1.13, R Parathyroidectomy rates seem to vary according to the availability of cinacalcet. This change in treatment strategy is accompanied with increased preoperative parathyroid hormone levels, reflecting delayed surgery and increased disease severity.
Sections du résumé
BACKGROUND
Since 2004, end-stage renal disease related hyperparathyroidism patients are treated mainly with cinacalcet, which ceased to be subsidized through the Australian Pharmaceutical Benefits Scheme in 2015. We aimed to investigate the impact of these changes on the treatment strategy in the Australian end-stage renal disease population.
METHODS
The following groups were formed according to the date of parathyroidectomy: A, before calcimimetics; B, during the era of calcimimetics; and C, after cinacalcet removal by the Australian Pharmaceutical Benefits Scheme. The primary outcome was time from start of dialysis to parathyroidectomy. Regression analysis was used to examine trends in parathyroidectomy rates.
RESULTS
Between 1998 and 2016, 195 parathyroidectomies were performed. Median time to referral was 69 (33-123), 67 (31-110) and 44 (23-102) months for groups A, B, and C, respectively (P = .55). Parathyroidectomy rates increased throughout the years (CI 0.09-1.13, R
CONCLUSION
Parathyroidectomy rates seem to vary according to the availability of cinacalcet. This change in treatment strategy is accompanied with increased preoperative parathyroid hormone levels, reflecting delayed surgery and increased disease severity.
Identifiants
pubmed: 30413324
pii: S0039-6060(18)30627-5
doi: 10.1016/j.surg.2018.04.092
pii:
doi:
Substances chimiques
Calcimimetic Agents
0
Parathyroid Hormone
0
Cinacalcet
UAZ6V7728S
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
135-141Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2018 Elsevier Inc. All rights reserved.