Expanding Outcomes Beyond Chronic Kidney Disease-Mineral and Bone Disorder: A Propensity Score-Matched Analysis of Parathyroidectomy versus Calcimimetics in Dialysis Patients with Secondary Hyperparathyroidism

作者：Hou YC, Zheng CM, Kuo KL, Tsai KW, Wang J, Wang CY, Chen RM, Lu KC · 发表于：International journal of medical sciences · 年份：2026 · DOI：10.7150/ijms.131653 · 被引用次数：42 · 研究领域：Hyperparathyroidism, Secondary、Parathyroidectomy、Kidney Failure, Chronic、Renal Dialysis、Calcimimetic Agents、Chronic Kidney Disease-Mineral and Bone Disorder、Humans、Female、Propensity Score、Retrospective Studies、Middle Aged、Male

BACKGROUND: Secondary hyperparathyroidism (SHPT) is a common complication in patients with end-stage renal disease (ESRD) receiving dialysis. Although calcimimetics (CAMs) and parathyroidectomy (PTx) are widely used for severe SHPT, their comparative effects on long-term clinical outcomes beyond mineral and bone disorder remain uncertain. METHODS: We conducted a retrospective multicenter cohort study using the TriNetX research network (2010-2024). Adult dialysis patients with ESRD and severe SHPT, defined by at least one historical intact parathyroid hormone level >600 pg/mL prior to treatment initiation, were included. Patients receiving both therapies were excluded. After 1:1 propensity score matching for demographics, comorbidities, medications, and laboratory variables, outcomes including all-cause mortality, major adverse cardiovascular events (MACE), fracture, cognitive impairment, mild cognitive impairment (MCI), and sepsis were compared using Cox proportional hazards models. RESULTS: After propensity score matching, 22,580 patients were included (11,290 in each group), with follow-up extending to 7 years. Compared with CAM therapy, PTx was associated with significantly lower risks of all-cause mortality (hazard ratio [HR] 0.914, 95% confidence interval [CI] 0.860-0.972), mild cognitive impairment (HR 0.646, 95% CI 0.436-0.955), and sepsis (HR 0.844, 95% CI 0.765-0.930). No significant differences were observed for MACE, fracture, hungry bone disease, overall cogniti...