Risk of Chronic Kidney Disease and Estimated Glomerular Filtration Rate Decline in Patients with Chronic Hypoparathyroidism: A Retrospective Cohort Study

Gosmanova, Elvira O.; Chen, Kristina; Rejnmark, Lars; Mu, Fan; Swallow, Elyse; Briggs, Allison; Ayodele, Olulade; Sherry, Nicole; Ketteler, Markus

doi:10.1007/s12325-021-01658-1

Cited by 30 publications

(29 citation statements)

References 21 publications

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“…This can be compared to the results of our study, showing a 3- to 4-fold increased risk of CKD and urolithiasis in both postsurgical and nonsurgical chronic hypoPT. More recently, Gosmanova et al, identified more than 8000 patients with chronic hypoPT on conventional treatment and showed an increased risk of incident CKD (HR 2.91; 95% CI, 2.61-3.25), progression of CKD stage and progression to end-stage kidney disease compared to persons without hypoPT during a 5-year follow-up ( 24 ). Bergenfelz et al showed an almost 5-fold increased risk of CKD in patients with postsurgical hypoPT in Sweden who underwent total thyroidectomy, compared with patients who underwent total thyroidectomy but did not develop postsurgical hypoPT ( 25 ).…”

Section: Discussionmentioning

confidence: 99%

Kidney Complications and Hospitalization in Patients With Chronic Hypoparathyroidism: A Cohort Study in Sweden

Swartling

Evans

Spelman

et al. 2022

The Journal of Clinical Endocrinology &Amp; Metabolism

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Context Kidney complications may be considerably higher in patients with chronic hypoparathyroidism (hypoPT) treated with activated vitamin D and calcium supplementation. Objective To investigate the risk of chronic kidney disease (CKD), urolithiasis and hospitalization in patients with chronic hypoPT. Design The Swedish National Patient Register, the Swedish Prescribed Drug Register and the Total Population Register, 1997–2018. Setting Population-based cohort study in Sweden. Patients National registries were used to identify patients with chronic hypoPT and controls matched by sex, age, and county of residence. Main Outcome Measures Incidence rates of hospitalization; time to CKD and urolithiasis diagnosis. Results A total of 1,562 patients with chronic hypoPT without preexisting CKD and 15,620 controls were included. The risk of developing CKD was higher in patients with chronic hypoPT compared with controls (hazard ratio [HR] 4.45, 95% confidence interval [CI] 3.66–5.41). In people without prior urolithiasis (n=1,810 chronic hypoPT and n=18,100 controls), the risk of developing urolithiasis was higher in patients with chronic hypoPT (HR 3.55, 95% CI 2.84–4.44) compared with controls. Patients with chronic hypoPT had higher incidence rates for all-cause hospitalization (49.59, 95% CI 48.50–50.70, per 100 person-years vs. 28.43, 95% CI 28.15–28.71, respectively) and for CKD (3.46, 95% CI 3.18–3.76, per 100 person-years vs. 0.72, 95% CI 0.68–0.77, respectively), compared to controls. Men with hypoPT appear to have a higher risk of CKD than women. Conclusions Patients with chronic hypoPT had an increased risk of CKD, urolithiasis, and hospitalization compared to controls.

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Section: Discussionmentioning

confidence: 99%

Kidney Complications and Hospitalization in Patients With Chronic Hypoparathyroidism: A Cohort Study in Sweden

Swartling

Evans

Spelman

et al. 2022

The Journal of Clinical Endocrinology &Amp; Metabolism

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“…In a study from Denmark, patients with hypoparathyroidism ( n = 688) had an almost fivefold increased risk of renal insufficiency compared with age- and gender-matched controls ( n = 2064) [ 5 ]. A retrospective cohort study from the USA showed that patients with chronic hypoparathyroidism ( n = 8097) had increased risk of developing incident CKD stage 3 or higher, and had increased risk of decline in eGFR ≥ 30% compared with patients without hypoparathyroidism ( n = 40,485) [ 2 ]. Moreover, a study conducted in Scotland identified a higher risk of renal failure, defined as eGFR < 30 mL/min, in patients with chronic hypoparathyroidism ( n = 280) compared with age- and gender-matched controls ( n = 1301) and showed that mean serum calcium concentration was associated with renal failure [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Five-Year Estimated Glomerular Filtration Rate in Adults with Chronic Hypoparathyroidism Treated with rhPTH(1-84): A Retrospective Cohort Study

Ayodele

Rejnmark

et al. 2022

Adv Ther

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Introduction Chronic hypoparathyroidism is associated with higher risk of developing chronic kidney disease compared with the general population. This study evaluated changes in estimated glomerular filtration rate (eGFR) over a 5-year period in adult patients with chronic hypoparathyroidism treated with recombinant parathyroid hormone (1-84), rhPTH(1-84), compared with a historical control cohort of patients who did not receive rhPTH(1-84). Methods This retrospective cohort study included patients with chronic hypoparathyroidism treated with rhPTH(1-84) in the REPLACE (NCT00732615), RELAY (NCT01268098), RACE (NCT01297309), and HEXT (NCT01199614 and continuation study NCT02910466) clinical trials. A historical control cohort who did not receive parathyroid hormone but who had enrollment criteria similar to those for the clinical trials was selected from the IBM® Explorys electronic medical record database (January 2007–August 2019). Outcomes of interest were the annual rate of change in eGFR from baseline (i.e., eGFR slope) and the predicted eGFR change from baseline at years 1 through 5. Results The study comprised 72 adult patients with chronic hypoparathyroidism treated with rhPTH(1-84) and 176 control patients who did not receive rhPTH(1-84). Over 5 years, eGFR remained stable in the rhPTH(1-84) cohort, whereas eGFR declined at a rate of 1.67 mL/min/1.73 m 2 per year in the control cohort ( P < 0.001 for eGFR slope in the control cohort). At 5 years, predicted eGFR in the rhPTH(1-84) cohort increased from baseline by 1.21 mL/min/1.73 m 2 , whereas eGFR in the control cohort declined by 10.36 mL/min/1.73 m 2 , after adjusting for baseline variables. The difference in eGFR slopes between the cohorts over 5 years was 1.37 mL/min/1.73 m 2 per year (95% CI 0.62–2.13; P < 0.001). Conclusion Long-term treatment with rhPTH(1-84) was associated with stable eGFR compared with eGFR decline in the controls not treated with rhPTH(1-84). Preservation of renal function conferred by rhPTH(1-84) may benefit patients with chronic hypoparathyroidism by reducing risk of long-term renal complications.

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“…In some patients, conventional therapy fails to adequately control hypoparathyroidism. Patients remain symptomatic, with episodes of hypocalcemia and hypercalcemia, and may develop complications, including chronic kidney disease (CKD) [1,3,[11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

“…Tis can lead to transient periods of hypercalcemia and hypercalciuria [1,3]. An increasing body of evidence indicates that patients with chronic hypoparathyroidism treated with conventional therapy are at increased risks for nephrolithiasis, nephrocalcinosis, developing a decline in eGFR, and progression to end-stage kidney disease [11,14,[16][17][18][19][20][21][22][23]. However, despite evidence for an association between CKD and hypoparathyroidism, little is known about which factors mediate this association.…”

Section: Introductionmentioning

confidence: 99%

Association of Calcium and Phosphate Levels with Incident Chronic Kidney Disease in Patients with Hypoparathyroidism: A Retrospective Case-Control Study

Gosmanova

Ayodele

Chen

et al. 2022

International Journal of Endocrinology

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Objective. Reasons for the increased incidence of chronic kidney disease (CKD) in patients with chronic hypoparathyroidism are poorly understood. This study evaluated associations between levels of albumin-corrected serum calcium, serum phosphate, and calcium-phosphate product and the odds of CKD development in patients with chronic hypoparathyroidism. Design. A retrospective nested case-control study of adult patients with chronic hypoparathyroidism who had ≥1 prescription for calcitriol who developed CKD and matched controls who did not develop CKD were selected from the IBM® Explorys electronic medical record database. Patients. The study included a cohort of 300 patients for the albumin-corrected serum calcium analysis and 80 patients for the serum phosphate and calcium-phosphate product analyses. Measurements. We examined associations between albumin-corrected serum calcium, serum phosphate and calcium-phosphate product levels, and the risk of devloping CKD (defined as ≥2 outpatient estimated glomerular filtration values <60 mL/min/1.73 m2 occuring ≥3 months apart or ≥1 diagnostic code for CKD stages 3–5). Results. Individuals who had ≥67% of albumin-corrected serum calcium measurements outside, above, or below the study-defined range (2.00–2.25 mmol/L [8.0–9.0 mg/dL]) had 3.5-, 2.9-, and 2.7-fold higher odds of developing CKD (adjusted odds ratios [95% CI]: 3.46 [1.82–6.56], 2.85 [1.30–6.28], and 2.68 [1.16–6.15]), respectively, compared with patients who had <33% of albumin-corrected calcium measurements in those ranges. There was no association between developing CKD and having any serum phosphate measurements or any calcium-phosphate product measurements above normal population ranges. Conclusion. In adult patients with chronic hypoparathyroidism, a higher proportion of albumin-corrected calcium measurements outside of the 2.00–2.25 mmol/L (8.0–9.0 mg/dL) range was associated with higher odds of developing CKD.

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Risk of Chronic Kidney Disease and Estimated Glomerular Filtration Rate Decline in Patients with Chronic Hypoparathyroidism: A Retrospective Cohort Study

Cited by 30 publications

References 21 publications

Kidney Complications and Hospitalization in Patients With Chronic Hypoparathyroidism: A Cohort Study in Sweden

Kidney Complications and Hospitalization in Patients With Chronic Hypoparathyroidism: A Cohort Study in Sweden

Five-Year Estimated Glomerular Filtration Rate in Adults with Chronic Hypoparathyroidism Treated with rhPTH(1-84): A Retrospective Cohort Study

Association of Calcium and Phosphate Levels with Incident Chronic Kidney Disease in Patients with Hypoparathyroidism: A Retrospective Case-Control Study

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