Carolyn Dacey Seib1, Calyani Ganesan2, Katherine D Arnow3, Insoo Suh4, Alan C Pao2, John T Leppert5, Manjula Kurella Tamura6, Amber W Trickey3, Electron Kebebew7. 1. Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE), Department of Surgery, Stanford University School of Medicine, Palo Alto, California; Department of Surgery, Stanford University School of Medicine, Palo Alto, California; Division of General Surgery, Palo Alto Veterans Affairs Health Care System, Palo Alto, California; Geriatric Research, Education and Clinical Center, Veterans Affairs Palo Alto, Palo Alto, California. Electronic address: cseib@stanford.edu. 2. Division of Nephrology, Stanford University School of Medicine, Palo Alto, California. 3. Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE), Department of Surgery, Stanford University School of Medicine, Palo Alto, California. 4. Department of Surgery, New York University Grossman School of Medicine, New York, New York. 5. Division of Nephrology, Stanford University School of Medicine, Palo Alto, California; Department of Urology, Stanford University School of Medicine, Palo Alto, California. 6. Geriatric Research, Education and Clinical Center, Veterans Affairs Palo Alto, Palo Alto, California; Division of Nephrology, Stanford University School of Medicine, Palo Alto, California. 7. Department of Surgery, Stanford University School of Medicine, Palo Alto, California.
Abstract
OBJECTIVE: Patients with primary hyperparathyroidism (PHPT) are at increased risk of kidney stones. Guidelines recommend parathyroidectomy in patients with PHPT with a history of stone disease. This study aimed to compare the 5-year incidence of clinically significant kidney stone events in patients with PHPT treated with parathyroidectomy versus nonoperative management. METHODS: We performed a longitudinal cohort study of patients with PHPT in a national commercial insurance claims database (2006-2019). Propensity score inverse probability weighting-adjusted multivariable regression models were calculated. RESULTS: We identified 7623 patients aged ≥35 years old with continuous enrollment >1 year before and >5 years after PHPT diagnosis. A total of 2933 patients (38.5%) were treated with parathyroidectomy. The cohort had a mean age of 66.5 years, 5953 (78.1%) were female, and 5520 (72.4%) were White. Over 5 years, the unadjusted incidence of ≥1 kidney stone event was higher in patients who were managed with parathyroidectomy compared with those who were managed nonoperatively overall (5.4% vs 4.1%, respectively) and among those with a history of kidney stones at PHPT diagnosis (17.9% vs 16.4%, respectively). On multivariable analysis, parathyroidectomy was associated with no statistically significant difference in the odds of a 5-year kidney stone event among patients with a history of kidney stones (odds ratio, 1.03; 95% CI, 0.71-1.50) or those without a history of kidney stones (odds ratio, 1.16; 95% CI, 0.84-1.60). CONCLUSION: Based on this claim analysis, there was no difference in the odds of 5-year kidney stone events in patients with PHPT who were treated with parathyroidectomy versus nonoperative management. Time horizon for benefit should be considered when making treatment decisions for PHPT based on the risk of kidney stone events. Published by Elsevier Inc.
OBJECTIVE: Patients with primary hyperparathyroidism (PHPT) are at increased risk of kidney stones. Guidelines recommend parathyroidectomy in patients with PHPT with a history of stone disease. This study aimed to compare the 5-year incidence of clinically significant kidney stone events in patients with PHPT treated with parathyroidectomy versus nonoperative management. METHODS: We performed a longitudinal cohort study of patients with PHPT in a national commercial insurance claims database (2006-2019). Propensity score inverse probability weighting-adjusted multivariable regression models were calculated. RESULTS: We identified 7623 patients aged ≥35 years old with continuous enrollment >1 year before and >5 years after PHPT diagnosis. A total of 2933 patients (38.5%) were treated with parathyroidectomy. The cohort had a mean age of 66.5 years, 5953 (78.1%) were female, and 5520 (72.4%) were White. Over 5 years, the unadjusted incidence of ≥1 kidney stone event was higher in patients who were managed with parathyroidectomy compared with those who were managed nonoperatively overall (5.4% vs 4.1%, respectively) and among those with a history of kidney stones at PHPT diagnosis (17.9% vs 16.4%, respectively). On multivariable analysis, parathyroidectomy was associated with no statistically significant difference in the odds of a 5-year kidney stone event among patients with a history of kidney stones (odds ratio, 1.03; 95% CI, 0.71-1.50) or those without a history of kidney stones (odds ratio, 1.16; 95% CI, 0.84-1.60). CONCLUSION: Based on this claim analysis, there was no difference in the odds of 5-year kidney stone events in patients with PHPT who were treated with parathyroidectomy versus nonoperative management. Time horizon for benefit should be considered when making treatment decisions for PHPT based on the risk of kidney stone events. Published by Elsevier Inc.
Entities:
Keywords:
health care utilization; kidney stones; nephrolithiasis; parathyroidectomy; primary hyperparathyroidism
Authors: Carolyn D Seib; Calyani Ganesan; Katherine D Arnow; Alan C Pao; John T Leppert; Nicolas B Barreto; Electron Kebebew; Manjula Kurella Tamura Journal: J Clin Endocrinol Metab Date: 2022-06-16 Impact factor: 6.134