Chronic Disease Research Group, Minneapolis Medical Research Foundation, 914 South 8th Street, Minneapolis, MN 55404, USA.
Am J Kidney Dis. 2011 Apr;57(4):602-11. doi: 10.1053/j.ajkd.2010.10.041. Epub 2010 Dec 24.
Parathyroidectomy rates in hemodialysis patients increased from 1992 to 2002, when medication choices to manage secondary hyperparathyroidism expanded.
Retrospective follow-up registry study.
SETTING & PARTICIPANTS: We evaluated annual cohorts of point-prevalent US hemodialysis patients with Medicare as primary payer for 1992-2007 (n = 1,063,258 for 1992-1999; 757,207 for 2000-2003; 902,119 for 2004-2007).
Comorbid conditions, vitamin D use, previous kidney transplant, and parathyroid hormone testing were assessed in the previous year. Available bone and mineral disorder treatment patterns were evaluated.
We examined incidence rate trends and patient characteristics through 2007 to estimate the association between parathyroidectomy and patient factors. Follow-up was from January 1 of each study year to the earliest in the same year of parathyroidectomy, death, or December 31.
We used χ(2) analysis to compare patient characteristics in 3 time frames. Unadjusted and adjusted parathyroidectomy rates were calculated. Cox regression was used to test the association of parathyroidectomy and covariates.
Adjusted parathyroidectomy rates increased from 1998 (7.0/1,000 patient-years; 1,045 events), peaked in 2002 (12.8/1,000 patient-years; 2,229 events), decreased through 2005 (5.4/1,000 patient-years; 1,078 events), and increased in 2006 (8.6/1,000 patient-years; 1,743 events) and 2007 (8.8/1,000 patient-years; 1,832 events). Vitamin D use, virtually undetectable in 1991, subsequently steadily increased; >80% of patients received vitamin D in 2006.
The study was not designed to provide causal explanations for observed changes; oral medication use trend data were limited to one large dialysis provider and may not reflect use patterns in all dialysis facilities; because Medicare is not the primary payer for all US hemodialysis patients, results do not describe the entire US hemodialysis population; parathyroid hormone values are lacking in the database.
Adjusted parathyroidectomy rates varied substantially from 1992 through 2007. Rates were highest in 1994 and 2002 and lowest in 1998 and 2005, likely influenced by changing medication use patterns and guideline publication.
1992 年至 2002 年间，接受甲状旁腺切除术的血液透析患者人数增加，这是因为管理继发性甲状旁腺功能亢进症的药物选择有所增加。
回顾性随访登记研究。
我们评估了 1992 年至 2007 年期间美国每年度点患病率血液透析患者队列，医疗保险为主要支付方（1992-1999 年为 1063258 例；2000-2003 年为 757207 例；2004-2007 年为 902119 例）。
评估了上一年的合并症、维生素 D 使用情况、先前的肾移植和甲状旁腺激素检测情况。评估了可用的骨和矿物质紊乱治疗模式。
我们通过 2007 年的趋势和患者特征来评估发病率，以估计甲状旁腺切除术与患者因素之间的关系。随访从当年的 1 月 1 日开始，直到同年最早的甲状旁腺切除术、死亡或 12 月 31 日结束。
我们使用 χ(2)分析比较了 3 个时间段的患者特征。计算了未经调整和调整后的甲状旁腺切除术发生率。使用 Cox 回归检验甲状旁腺切除术与协变量的相关性。
调整后的甲状旁腺切除术发生率从 1998 年（每 1000 患者年 7.0；1045 例事件）上升，在 2002 年达到高峰（每 1000 患者年 12.8；2229 例事件），随后在 2005 年下降（每 1000 患者年 5.4；1078 例事件），在 2006 年再次增加（每 1000 患者年 8.6；1743 例事件）和 2007 年（每 1000 患者年 8.8；1832 例事件）增加。维生素 D 的使用在 1991 年几乎检测不到，随后逐渐增加；2006 年超过 80%的患者接受了维生素 D。
该研究并非旨在为观察到的变化提供因果解释；口服药物使用趋势数据仅限于一家大型透析机构，可能无法反映所有透析机构的使用模式；由于医疗保险并非所有美国血液透析患者的主要支付方，因此研究结果无法描述整个美国血液透析人群；数据库中缺乏甲状旁腺激素值。
从 1992 年到 2007 年，调整后的甲状旁腺切除术率有很大差异。1994 年和 2002 年的比率最高，1998 年和 2005 年的比率最低，这可能受到药物使用模式和指南发布变化的影响。
