V KAREPALLI1, A ABEYARATNE1, M MOGULLA1, K PRIYADARSHANA1
1Royal Darwin Hospital, Nightcliff, Australia
Aim: To evaluate the effect of Cinacalcet cessation on biochemical markers and rates of Parathyroidectomy in Topend of Northern Territory.
Background: Secondary hyperparathyroidism is a well-known complication in Chronic Kidney Disease. Hyperparathyroidism is associated with bone pain, fractures, vascular calcification and increased cardiovascular risk. According to the EVOLVE study, Cinacalcet did not show benefit in reducing the cardiovascular mortality but significantly reduced the requirement for Parathyroidectomy. Due to the limited resources, number of Parathyroidectomies performed in Northern Territory is lower compared to rest of the Australia. Since Cinacalcet was PBS-delisted in August 2015 Parathyroidectomy became the only treatment option available. In Northern Territory Parathyroidectomies are performed only at Royal Darwin Hospital.
Methods: We collected retrospective data from electronic records on Parathyroidectomies (n =19) performed in Royal Darwin Hospital between 2012 and 2018. We included the total number of patients on Cinacalcet (n=42) before August 2015 and excluded the paediatric population. We conducted standard t-test to analyse the difference in biochemical parameters with effect to Cinacalcet.
Results: The number of Parathyroidectomies increased from two per year to four per year post cessation of Cinacalcet. Nearly half of these patients were on Cinaclacet until it was PBS-delisted. Mean PTH levels increased from 140.8 pmol/l to 176.4 pmol/l and mean Calcium levels increased from 2.27 mmol/l to 2.34 mmol/l, whereas mean phosphate levels were decreased from 1.75 mmol/l to 1.41 mmol/l.
Conclusions: Cinacalcet cessation led to increase in PTH levels and the number of parathyroidectomies in Northern Territory. We need further analysis into risk of fractures in association with Cinacalcet cessation and cost analysis to postulate the advantage.
First year Renal Advance Trainee at Royal Darwin Hospital.