Effectiveness of cinacalcet treatment for secondary hyperparathyroidism on hospitalization: Results from the MBD-5D study

Bibliometric insights in surgical treatment of secondary hyperparathyroidism: Research status, hotspots, and global trends

Secondary hyperparathyroidism (SHPT) is mainly seen in advanced chronic kidney failure, and its main clinical feature is an increase in the synthesis and secretion of parathyroid hormone. Surgical treatment is typically considered when the parathyroid hormone level remains consistently above 800 pg/mL and is accompanied by hypercalcemia or when conservative treatment is ineffective. Secondary hyperparathyroidism may manifest as bone and joint pain, mental abnormalities, skin itching, and hyperpigmentation. There are 3 main surgical approaches for parathyroidectomy (PTX): subtotal PTX (sPTX), total PTX with parathyroid auto-transplantation (TPTX + AT) and total PTX without parathyroid auto-transplantation (TPTX). Complications that may arise after PTX include unsatisfactory surgical outcomes, recurrence, bone mineral disease and hungry bone syndrome. In this study, nearly 3 decades of scientific articles about the surgical treatment of SHPT were analyzed and summarized to gain a better understanding by using bibliometric method. 1389 publications from 1990 and 2023 were included in the WoS database through systematic retrieval. The general information was characterized, and the developmental skeleton and research frontiers were explored. CiteSpace was used to evaluate and visualize the results. 1389 publications were included in the results, and the frequency of citations was 15,688. The top 5 countries for the number of literatures published were USA, China, Japan, Italy, and Germany; The top 5 countries for literature centrality were USA, France, England, Romania, and Sweden. There are 10 institutions which the number of literatures from each institution was more than 20. The top 10 institutions all scored 0.04 or above for their Centrality score, which indicates that research in this area was relatively intensive and that there is much co-operation between institutions. The most cited authors were mainly from Japan and USA. Journals, such as Surgery World J Surg, J Clin Endocr Metab, Kidney Int, had greater influence in this field. Keyword analysis results showed that research mainly focuses on parathyroid hormone, surgery, chronic renal failure and subtotal parathyroidectomy. This bibliometric study provides a comprehensive analysis of global productivity, collaboration, and research hotspots within the Surgical treatment of secondary hyperparathyroidism, which will aid in directing research toward endoscopic thyroidectomy in the coming years.

Associations Between Inflammatory and Bone Turnover Markers and Mortality in Hemodialysis Patients

Background/Objectives: Chronic kidney disease-mineral and bone disorder (CKD-MBD) and systemic inflammation contribute to mortality in hemodialysis (HD) patients. The primary aim of this study was to determine whether specific CKD-MBD markers and inflammatory biomarkers are associated with increased mortality risk in HD patients. Methods: We conducted a retrospective cohort study on 63 stage 5D CKD patients undergoing maintenance HD. Serum intact parathyroid hormone (iPTH), soluble Klotho, calcium, phosphorus, 25(OH)D (25-hydroxyvitamin D), transforming growth factor-beta (TGF-β), vascular endothelial growth factor (VEGF), C-reactive protein (CRP), and interleukin-6 (IL-6) were analyzed. A Cox regression analysis assessed mortality predictors, and linear regression analysis evaluated CKD-MBD-inflammation correlations. Results: Lower iPTH (<329.3 pg/mL) levels were the only significant mortality predictor (p = 0.042). Other CKD-MBD markers (calcium, phosphorus, 25(OH)D, VEGF, TGF-β) did not impact survival. Soluble Klotho correlated positively with IL-6 (r = 0.57, p < 0.001), suggesting a compensatory inflammatory response. Conclusions: Our findings demonstrate that low iPTH levels and advanced age are independent predictors of mortality in hemodialysis patients. The positive association between soluble Klotho and IL-6 suggests a potential compensatory inflammatory response. These results highlight the need for further research to clarify underlying mechanisms and to explore novel therapeutic strategies.

Cinacalcet adherence in dialysis patients with secondary hyperparathyroidism in Lombardy Region: clinical implications and costs

Background

Patients on dialysis often have secondary hyperparathyroidism (SHPT), a disorder associated with renal osteodystrophy, progressive vascular calcification, cardiovascular disease, and death. The objective of this retrospective observational study was to evaluate, in dialysis patients with SHPT, the impact of different levels of adherence to cinacalcet therapy on hospitalisations and direct healthcare costs charged to the Lombardy Regional Health Service (Italy).

Methods

Data recorded in the administrative databases on all citizens undergoing dialysis between 1 January 2011 and 31 December 2011 were selected. For the aim of this study, patients with SHPT already on dialysis in the first 6 months of 2009 who had been treated with cinacalcet for at least 365 days were selected and retrospectively analysed through to end of 2012. Healthcare resource utilisation, cinacalcet adherence, and costs for medication, hospitalisations, and diagnostic/therapeutic procedures were estimated.

Results

A total of 994 patients were identified (mean age 63.0 years, females 43.5%). The first patient tertile had an adherence to cinacalcet of <64.1%, whereas the third had an adherence of over 91.5%. Patients in the third adherence tertile experienced fewer all-causes hospitalisations than those in the first tertile (-19.2%; p=0.01423), fractures (-37.1%; p=0.59422), cardiovascular disease (-23.8%; p=0.04025), and sepsis (-32.3%; p=0.01386). The increase in costs for cinacalcet-adherent patients is almost completely offset by the reduction in costs for hospitalisations.

Conclusions

The results of the analysis suggest that there may be some correlation between a high level of cinacalcet adherence and a decrease in hospitalisations.