A retrospective comparison of the effects of calcimimimetic therapy and surgical treatment in hemodialysis patients with secondary hyperparathyroidism

Objective: The aim of this study was to evaluate the results of calcimimetic therapy and surgical treatment in the treatment of secondary hyperparathyroidism, which significantly increases the risk of morbidity and mortality in hemodialysis patients, and to examine their effects on morbidity and mortality. Materials and Methods: Between January 2015 and December 2022, 98 hemodialysis patients who were followed up in the hemodialysis unit, endocrinology outpatient clinic and nephrology outpatient clinic of Karadeniz Technical University Faculty of Medicine Farabi Hospital and who underwent calcimimimetic therapy or surgical treatment for secondary hyperparathyroidism were included in the study. Patients under 18 years of age, pregnant women, and patients without adequate hospital records and procedures were excluded from the study. Ca, P, CaxP, PTH, Hb, Ferritin, Crp, Lymphocytes, Neutrophils and mortality and morbidity at baseline, 6, 12 and 18 months of treatment were compared. SPSS 23.0 statistical package program was used for data analysis. Mann-whitney u and chi-square statistical analyses were performed. Descriptive analyses of the evaluation results were given as number (n) and percentage (%) for categorical variables, and mean (mean), standard deviation (SD), median (median), minimum (min), and maximum (max) values for numerical variables. The effect of treatment on the change in laboratory values over time was analyzed using repeated measures analysis of variance separately according to disease groups. The p values obtained as a result of statistical analyses were evaluated at α= 0.05 significance level with 95% confidence interval and comparisons were considered statistically significant when p values were less than 0.05. Results: A total of 98 patients over the age of 18 years were included in our study. The mean age of all patients was 49.60±14.54 years. Of the patients included in the study, 40 were female (40.8%) and 58 were male (59.2%). While 78 patients received cinecalcet treatment, 20 patients underwent parathyroidectomy. After 18 months of follow-up, lower Ca, P, CaxP, PTH, Ferritin levels were observed in the parathyroidectomized patient group, less heart failure developed and no exitus occurred during follow-up. There was no difference between the two treatment modalities in terms of development of anemia or change in the need for treatment for anemia. Conclusion: After 18 months of follow-up, serum Ca, P, CaxP, PTH levels were significantly lower in the parathyroidectomy group than in the calcimimimetic group, suggesting that parathyroidectomy was more effective than calcimimetic treatment in the treatment of secondary hyperparathyroidism. The fact that the ferritin level was significantly lower in the surgical group than in the calcimimetic treatment group and the CRP level was lower than in the calcimimimetic treatment group even though it was not statistically significant, it was concluded that inflammation was less in the surgical group and the risk of complications that may develop due to this would be less. Keywords: Hemodialysis, Secondary Hyperparathyroidism, Cinecalcet, Parathyroidectomy