Yonsei University College of Medicine Seoul, Republic of Korea
Background:
Secondary hyperparathyroidism (SHPT) is associated with vascular calcification, peritonitis, and increased mortality in patients undergoing peritoneal dialysis (PD). Although calcimimetics are recommended to control parathyroid hormone (PTH) and calcium levels, real-world evidence on their effects in PD populations remains limited. We aimed to evaluate the association between calcimimetic use and long-term outcomes in PD patients with SHPT.
Methods:
The Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) is a prospective cohort study of adults (=18 years) designed to identify modifiable practices associated with improved PD outcomes and survival. Among 766 patients randomly selected from 20 of 81 centers in Korea, we included those with SHPT, defined as PTH >300 pg/mL on at least two measurements. Patients with acute kidney injury at PD initiation, prior parathyroidectomy, or hybrid dialysis within 4 months of enrollment were excluded. Patients were stratified by calcimimetic use (calcimimetics, n=64; no calcimimetics, n=47). The primary outcome was all-cause mortality; secondary outcomes were peritonitis and transition to hemodialysis.
Results:
Mean age was similar between groups (50 vs 51 years; p=0.643), as were baseline calcium and phosphorus levels. Patients receiving calcimimetics had higher baseline PTH (p=0.009) and longer dialysis vintage (p < 0.001), indicating more advanced disease. In survival analyses, calcimimetic use was not associated with differences in all-cause mortality (log-rank p=0.90), peritonitis (p=0.50), or transition to hemodialysis (p=0.60). Among calcimimetic users, outcomes were similar between patients with moderate (300-600 pg/mL) and severe (=600 pg/mL) PTH levels.
Conclusions:
In this real-world PD cohort, calcimimetics were preferentially prescribed to patients with more severe SHPT and longer dialysis vintage, but were not associated with improved clinical outcomes. Further studies are needed to clarify calcimimetics' role in SHPT in PD.
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