Association of secondary hyperparathyroidism with CKD progression, health care costs and survival in diabetic predialysis CKD patients

Nephron Clin Pract. 2009;113(1):c54-61. doi: 10.1159/000228076. Epub 2009 Jul 10.


Background/aims: The objective of this study was to examine health care costs and utilization and the risks of dialysis or mortality among diabetic predialysis chronic kidney disease (CKD) patients with and without secondary hyperparathyroidism (SHPT).

Methods: This retrospective, matched cohort study examined insurance claims from 703 adult diabetic predialysis CKD patients with and without SHPT during a 72-month follow-up period. Annualized estimates of health care service utilization, costs and disease progression to dialysis or death following index CKD diagnosis were compared.

Results: Preindex (baseline) characteristics were similar between the cohorts. Postindex numbers of prescription utilization, outpatient service utilization and hospitalizations were all higher (p < 0.0001) in diabetic CKD patients with SHPT compared to those without SPHT in both unadjusted and adjusted analyses even after multivariate adjustment for known confounders. The rate of progression to dialysis or death was higher for diabetic CKD patients with SHPT compared to those without SPHT. Those with SHPT were at higher risk of requiring dialysis treatment [hazard ratio (HR) = 6.7; 95% confidence interval (CI) = 4.3-10.6] and death (HR = 2.3; 95% CI = 1.1-4.9) compared to those without SHPT.

Conclusion: In diabetic predialysis CKD patients, the presence of SHPT is associated with significantly greater health care resource utilization and costs, and a faster rate of disease progression.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Ambulatory Care / economics
  • Ambulatory Care / statistics & numerical data
  • Chelation Therapy / statistics & numerical data
  • Cohort Studies
  • Comorbidity
  • Diabetic Nephropathies / complications*
  • Diabetic Nephropathies / drug therapy
  • Diabetic Nephropathies / economics
  • Diabetic Nephropathies / mortality
  • Disease Progression
  • Drug Costs / statistics & numerical data
  • Female
  • Health Care Costs*
  • Health Resources / economics
  • Health Resources / statistics & numerical data*
  • Hospital Costs / statistics & numerical data
  • Hospitalization / economics
  • Hospitalization / statistics & numerical data
  • Humans
  • Hyperparathyroidism, Secondary / economics
  • Hyperparathyroidism, Secondary / epidemiology*
  • Hyperparathyroidism, Secondary / etiology
  • Hyperphosphatemia / etiology
  • Insurance, Health, Reimbursement / statistics & numerical data
  • Longevity
  • Male
  • Middle Aged
  • Phosphorus
  • Retrospective Studies
  • Survival Analysis


  • Phosphorus