Carolyn D Seib1,2,3,4, Calyani Ganesan5, Katherine D Arnow1, Alan C Pao5,6, John T Leppert5,6, Nicolas B Barreto1, Electron Kebebew2, Manjula Kurella Tamura4,5. 1. Stanford-Surgery Policy Improvement Research and Education Center, Department of Surgery, Stanford University School of Medicine, Palo Alto, CA 94304, USA. 2. Department of Surgery, Stanford University School of Medicine, Palo Alto, CA 94305, USA. 3. Division of General Surgery, Palo Alto Veterans Affairs Health Care System, Palo Alto, CA 94304, USA. 4. Geriatric Research, Education and Clinical Center, Veterans Affairs Palo Alto, Palo Alto, CA 94304, USA. 5. Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA 94305, USA. 6. Department of Urology, Stanford University School of Medicine, Palo Alto, CA 94305, USA.
Abstract
CONTEXT: Primary hyperparathyroidism (PHPT) is associated with an increased risk of kidney stones. Few studies account for PHPT severity or stone risk when comparing stone events after parathyroidectomy vs nonoperative management. OBJECTIVE: Compare the incidence of kidney stone events in PHPT patients treated with parathyroidectomy vs nonoperative management. DESIGN: Longitudinal cohort study with propensity score inverse probability weighting and multivariable Cox proportional hazards regression. SETTING: Veterans Health Administration integrated health care system. PATIENTS: A total of 44 978 patients with > 2 years follow-up after PHPT diagnosis (2000-2018); 5244 patients (11.7%) were treated with parathyroidectomy. MAIN OUTCOMES MEASURE: Clinically significant kidney stone event. RESULTS: The cohort had a mean age of 66.0 years, was 87.8% male, and 66.4% White. Patients treated with parathyroidectomy had higher mean serum calcium (11.2 vs 10.8mg/dL) and were more likely to have a history of kidney stone events. Among patients with baseline history of kidney stones, the unadjusted incidence of ≥ 1 kidney stone event was 30.5% in patients managed with parathyroidectomy (mean follow-up, 5.6 years) compared with 18.0% in those managed nonoperatively (mean follow-up, 5.0 years). Patients treated with parathyroidectomy had a higher adjusted hazard of recurrent kidney stone events (hazard ratio [HR], 1.98; 95% CI, 1.56-2.51); however, this association declined over time (parathyroidectomy × time: HR, 0.80; 95% CI, 0.73-0.87). CONCLUSION: In this predominantly male cohort with PHPT, patients treated with parathyroidectomy continued to be at higher risk of kidney stone events in the immediate years after treatment than patients managed nonoperatively, although the adjusted risk of stone events declined with time, suggesting a benefit to surgical treatment. Published by Oxford University Press on behalf of the Endocrine Society 2022.
CONTEXT: Primary hyperparathyroidism (PHPT) is associated with an increased risk of kidney stones. Few studies account for PHPT severity or stone risk when comparing stone events after parathyroidectomy vs nonoperative management. OBJECTIVE: Compare the incidence of kidney stone events in PHPT patients treated with parathyroidectomy vs nonoperative management. DESIGN: Longitudinal cohort study with propensity score inverse probability weighting and multivariable Cox proportional hazards regression. SETTING: Veterans Health Administration integrated health care system. PATIENTS: A total of 44 978 patients with > 2 years follow-up after PHPT diagnosis (2000-2018); 5244 patients (11.7%) were treated with parathyroidectomy. MAIN OUTCOMES MEASURE: Clinically significant kidney stone event. RESULTS: The cohort had a mean age of 66.0 years, was 87.8% male, and 66.4% White. Patients treated with parathyroidectomy had higher mean serum calcium (11.2 vs 10.8mg/dL) and were more likely to have a history of kidney stone events. Among patients with baseline history of kidney stones, the unadjusted incidence of ≥ 1 kidney stone event was 30.5% in patients managed with parathyroidectomy (mean follow-up, 5.6 years) compared with 18.0% in those managed nonoperatively (mean follow-up, 5.0 years). Patients treated with parathyroidectomy had a higher adjusted hazard of recurrent kidney stone events (hazard ratio [HR], 1.98; 95% CI, 1.56-2.51); however, this association declined over time (parathyroidectomy × time: HR, 0.80; 95% CI, 0.73-0.87). CONCLUSION: In this predominantly male cohort with PHPT, patients treated with parathyroidectomy continued to be at higher risk of kidney stone events in the immediate years after treatment than patients managed nonoperatively, although the adjusted risk of stone events declined with time, suggesting a benefit to surgical treatment. Published by Oxford University Press on behalf of the Endocrine Society 2022.
Authors: Michael W Yeh; Hui Zhou; Annette L Adams; Philip H G Ituarte; Ning Li; In-Lu Amy Liu; Philip I Haigh Journal: Ann Intern Med Date: 2016-04-05 Impact factor: 25.391
Authors: Andrew S Levey; Lesley A Stevens; Christopher H Schmid; Yaping Lucy Zhang; Alejandro F Castro; Harold I Feldman; John W Kusek; Paul Eggers; Frederick Van Lente; Tom Greene; Josef Coresh Journal: Ann Intern Med Date: 2009-05-05 Impact factor: 25.391
Authors: Calyani Ganesan; Benjamin Weia; I-Chun Thomas; Shen Song; Kyla Velaer; Carolyn D Seib; Simon Conti; Chris Elliott; Glenn M Chertow; Manjula Kurella Tamura; John T Leppert; Alan C Pao Journal: JAMA Surg Date: 2020-09-01 Impact factor: 16.681
Authors: Carolyn Dacey Seib; Calyani Ganesan; Katherine D Arnow; Insoo Suh; Alan C Pao; John T Leppert; Manjula Kurella Tamura; Amber W Trickey; Electron Kebebew Journal: Endocr Pract Date: 2021-06-11 Impact factor: 3.443