Clinical Nephrology – Epidemiology – Clinical Trials

Kidney International (2004) 65, 282–288; doi:10.1111/j.1523-1755.2004.00368.x

Parathyroidectomy rates among United States dialysis patients: 1990–19991

BRYAN KESTENBAUM, STEPHEN L SELIGER, DANIEL L GILLEN, HAIMANOT WASSE, BESSIE YOUNG, DONALD J SHERRARD, NOEL S WEISS and CATHERINE O STEHMAN-BREEN

University of Washington Department of Medicine, Division of Nephrology, Seattle, Washington; University of Washington Department of Biostatistics, Seattle, Washington; University of Washington, Veterans' Affairs Puget Sound Health Care System, Division of General Internal Medicine, Seattle, Washington; University of Washington, Department of Epidemiology, Seattle, Washington; and University of Washington, Veterans' Affairs Puget Sound Health Care System, Division of Nephrology, Seattle, Washington

Correspondence: Bryan Kestenbaum M.D. MS., Division of Nephrology, Box 3565221 BB 1265, Health Sciences Building, 1959 NE Pacific, Seattle, WA 98195. E-mail:epware@earthlink.net

1See Editorial by Goodman, p. 335.

Received 17 June 2003; Revised 31 July 2003; Accepted 15 August 2003.

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Abstract

Parathyroidectomy rates among United States dialysis patients: 1990–1999.

Background

 

Medical therapy for secondary hyperparathyroidism (SHPTH) has evolved considerably during the past decade. It is not known how changes in medical therapy might impact the parathyroidectomy (PTX) rate among dialysis patients. Relatively low parathyroid hormone (PTH) levels have been found among elderly dialysis patients and those with diabetes. Clinical factors associated with differing PTX rates among United States dialysis patients have not been reported. We report PTX rates in the United States from 1990 to 1999 among persons with end-stage renal disease, accounting for changes in patient characteristics.

Methods

 

Data from the United States Renal Database were utilized. Patients insured by Medicare or Medicaid and receiving renal replacement therapy between January 1, 1990, and December 31, 1999 were considered for analysis. PTX was determined by ICD-9 procedure codes. Multivariate Poisson models were used to estimate adjusted PTX rates.

Results

 

The overall observed PTX rate in the study sample was 7.16 per 1000 person-years at risk. After a slight rise during the early 1990s, adjusted PTX rates declined by approximately 30% between 1995 and 1999. Adjusted PTX rates were higher among patients who were younger, female, nondiabetic, receiving peritoneal dialysis, and those with a longer cumulative duration of dialysis.

Conclusion

 

PTX rates have recently decreased in the United States, independent of changes in patient characteristics. The effectiveness of medical therapy in targeting secondary hyperparathyroidism may be improving. Younger, nondiabetic patients with a longer cumulative dialysis burden are at particularly high risk for PTX.

Keywords:

parathyroidectomy, rates, incidence, dialysis, diabetes

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