Parathyroidectomy vs Cinacalcet Among Patients Undergoing Hemodialysis

J Clin Endocrinol Metab. 2022 Jun 16;107(7):2016-2025. doi: 10.1210/clinem/dgac142.


Context: Parathyroidectomy (PTx) and cinacalcet are both effective treatments for secondary hyperparathyroidism in hemodialysis patients, but limited data exist comparing the long-term outcomes of these interventions.

Objective: We aimed to compare the risk of mortality among hemodialysis patients who underwent PTx and those who started treatment with cinacalcet.

Methods: In this prospective cohort study, comprising patients from the Japanese Society for Dialysis Therapy Renal Data Registry, patients who had intact parathyroid hormone (PTH) levels ≥ 300 pg/mL in late 2007 and underwent PTx or started treatment with cinacalcet in 2008 to 2009 were matched by propensity score at 1:3. PTx and cinacalcet were compared for all-cause mortality within 6 years.

Results: Among eligible patients, 894 patients who underwent PTx were matched with 2682 patients who started treatment with cinacalcet. The median baseline intact PTH levels were 588 pg/mL and 566 pg/mL in the PTx and cinacalcet groups, respectively. PTx resulted in greater reductions in intact PTH, calcium, and phosphorus levels compared with cinacalcet. During the 6-year follow-up period, 201 patients (22.5%) in the PTx group and 736 patients (27.4%) in the cinacalcet group died. PTx was associated with a lower risk of mortality compared with cinacalcet (hazard ratio, 0.78 [95% CI, 0.67-0.91]; P = 0.002). This association was more pronounced in patients with intact PTH levels ≥ 500 pg/mL and in patients with serum calcium levels ≥ 10.0 mg/dL (both P for interaction < 0.001).

Conclusion: PTx compared with cinacalcet is associated with a lower risk of mortality, particularly among patients with severe secondary hyperparathyroidism.

Keywords: cinacalcet; fracture; hemodialysis; mortality; parathyroidectomy; secondary hyperparathyroidism.

Publication types

  • Comparative Study

MeSH terms

  • Calcium
  • Cinacalcet* / therapeutic use
  • Humans
  • Hyperparathyroidism, Secondary* / drug therapy
  • Hyperparathyroidism, Secondary* / etiology
  • Hyperparathyroidism, Secondary* / surgery
  • Parathyroid Hormone
  • Parathyroidectomy*
  • Prospective Studies
  • Renal Dialysis / mortality


  • Parathyroid Hormone
  • Calcium
  • Cinacalcet