Comparison of the outcomes of correction of secondary hyperparathyroidism by parathyroidectomy and etelcalcetide therapy in real clinical practice

Abstract

To date, there is no universal approach to choosing the optimal management strategy for patients with SHPT, including the choice between calcimimetics or parathyroidectomy (PTX). THE AIM: to compare the survival rate of patients with uncontrolled SHPT on etelcalcetide therapy and after PTX, as well as to identify additional factors influencing treatment outcomes. PATIENTS AND METHODS. A retrospective cohort comparative study included two groups of hemodialysis patients: 55 patients who received etelcalcetide in 2018-2019 at 20 dialysis centers and 84 patients who underwent PTX in 2011-2016. The groups were compared at baseline by key demographic and clinical parameters. The main endpoint was patient survival (Kaplan-Meyer). Secondary endpoints included the risks of death in the Cox multiple regression analysis. RESULTS. In the etelcalcetide group, 12/55 patients died over a three-year period, and 4/84 in the PTX group (p=0.003). Survival by 36 months was 72.0±7.1 % in the etelcalcetide group and 91.8±4.1 % in the PTX group (p=0.014). Multiple Cox regression analysis showed a significant reduction in the risk of death in patients after PTX (HR 0.19; 95 % CI 0.06–0.60, p=0.004). Achieving the target PTH level (300-600 pg/ml) after PTX is associated with better survival (HR 0.12; 95 % CI 0.02–0.95, p=0.045). Perhaps the preferred target level for PTX (but not for drug therapy) is the range of 150-600 pg/ml. CONCLUSIONS. Patients with uncontrolled SHPT (PTH>1000 pg/ml) who have undergone PTX have a better survival rate compared to patients receiving etelcalcetide. Achieving the target level of PTH (150-600 pg/ml) 6 months after PTX can be considered as a prognostically favorable factor. In conditions of limited access to etelcalcetide therapy for severe hyperparathyroidism, PTX is the preferred method of correcting HCG.