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Clinical outcomes of parathyroidectomy versus cinacalcet in the clinical management of secondary hyperparathyroidism

Authors
 Won Woong Kim  ;  Yumie Rhee  ;  Beom Seok Kim  ;  Kwangsoon Kim  ;  Cho Rok Lee  ;  Sang-Wook Kang  ;  Jandee Lee  ;  Jong Ju Jeong  ;  Kee-Hyun Nam  ;  Woong Youn Chung 
Citation
 ENDOCRINE JOURNAL, Vol.66(10) : 881-889, 2019 
Journal Title
 ENDOCRINE JOURNAL 
ISSN
 0918-8959 
Issue Date
2019
Keywords
Cinacalcet ; Mineral and bone disorder ; Parathyroidectomy ; Secondary hyperparathyroidism ; Survival
Abstract
Parathyroidectomy (PTX) is the standard treatment for secondary hyperparathyroidism (SHPT); however, the administration of cinacalcet has gained prominence as a noninvasive treatment. We aimed to determine whether PTX or cinacalcet is more effective in preventing morbidity and mortality through reviewing follow-up data concerning surgical management of SHPT. We retrospectively analyzed and divided 209 patients with SHPT into two treatment groups: PTX (n = 78) and cinacalcet (n = 131) groups. We compared clinical features, the over-the-target range rate during pre- and post-intervention periods, new cardiovascular events, and all-cause mortality between both groups. Almost all biochemical parameters were well controlled in the post-intervention period, and were within the recommended target range for the PTX group but not for the cinacalcet group. A significant difference was observed in the over-the-target range rate during the post-intervention period between the groups. PTX and cinacalcet interventions significantly lowered the over-the-target range rates for serum intact parathyroid hormone (iPTH) (>300 pg/mL), corrected calcium (>10.5 mg/mL), serum phosphorus (>5.5 mg/dL), and calcium-phosphorus product (>55) in both groups (p = 0.001). PTX reduced the risk of new cardiovascular events by 86% compared to cinacalcet (p = 0.001); however, all-cause mortality did not differ significantly (14.1% vs. 7.6%, p = 0.132). For patients with SHPT, PTX helps prevent cardiovascular events through normalizing biochemical variables, according to recommended guidelines. PTX should be considered before cinacalcet treatment to prevent new cardiovascular events. Early PTX for appropriate patients can help prevent immediate postoperative complications and mortality.
Files in This Item:
T201904525.pdf Download
DOI
10.1507/endocrj.EJ19-0036
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Sang Wook(강상욱) ORCID logo https://orcid.org/0000-0001-5355-833X
Kim, Kwang Soon(김광순)
Kim, Beom Seok(김범석) ORCID logo https://orcid.org/0000-0002-5732-2583
Kim, Won Woong(김원웅)
Nam, Kee Hyun(남기현) ORCID logo https://orcid.org/0000-0002-6852-1190
Rhee, Yumie(이유미) ORCID logo https://orcid.org/0000-0003-4227-5638
Lee, Jan Dee(이잔디) ORCID logo https://orcid.org/0000-0003-4090-0049
Lee, Cho Rok(이초록) ORCID logo https://orcid.org/0000-0001-7848-3709
Chung, Woong Youn(정웅윤)
Jeong, Jong Ju(정종주) ORCID logo https://orcid.org/0000-0002-4155-6035
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/173350
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