Department of General Internal Medicine and Nephrology, Robert-Bosch-Krankenhaus, Stuttgart, Germany.
University of Split School of Medicine (USSM), Split, Croatia.
Adv Ther. 2021 Apr;38(4):1946-1957. doi: 10.1007/s12325-021-01649-2. Epub 2021 Mar 11.
Chronic hypoparathyroidism managed with conventional treatment, comprising oral administration of calcium and active vitamin D, has been associated with renal complications, including nephrolithiasis and nephrocalcinosis. Further larger-scale studies are needed to examine these risks. This study evaluated the risk of nephrolithiasis and nephrocalcinosis in patients with chronic hypoparathyroidism.
A retrospective cohort study using a managed care claims database in the United States from January 2007 to June 2017. Included patients were those with chronic hypoparathyroidism (excluding those receiving parathyroid hormone) and randomly selected patients without hypoparathyroidism over a maximum of 5-year follow-up. The main outcome measures were nephrolithiasis, identified by diagnosis codes or procedure codes for removing kidney stones, and nephrocalcinosis, identified by diagnosis codes.
The nephrolithiasis analyses included 8097 adult patients with hypoparathyroidism and 40,485 adult patients without hypoparathyroidism. After excluding patients with a diagnosis of nephrocalcinosis at baseline, nephrocalcinosis analyses included 8051 patients with hypoparathyroidism and 40,466 patients without hypoparathyroidism. During 5 years of follow-up, patients with chronic hypoparathyroidism had significantly increased risk of nephrolithiasis and nephrocalcinosis in Kaplan-Meier analysis compared with patients without hypoparathyroidism (both P < 0.001). In the adjusted analyses, chronic hypoparathyroidism was associated with higher risks of nephrolithiasis (hazard ratio [HR], 1.81; 95% confidence interval [CI] 1.60-2.04) and nephrocalcinosis (HR, 6.94; 95% CI 4.41-10.92). A sensitivity analysis restricted to patients with at least one kidney imaging examination showed that 2.6% of patients (n = 59) with hypoparathyroidism and 0.5% of patients (n = 20) without hypoparathyroidism (ratio, 5.5; P < 0.001) developed nephrocalcinosis.
This large retrospective cohort study showed a statistically significant and clinically meaningful increased risk of nephrolithiasis and nephrocalcinosis in patients who have chronic hypoparathyroidism compared with those who do not have chronic hypoparathyroidism.
接受常规治疗（包括口服钙和活性维生素 D）的慢性甲状旁腺功能减退症与肾脏并发症有关，包括肾结石和肾钙质沉着症。需要进一步进行更大规模的研究来评估这些风险。本研究评估了慢性甲状旁腺功能减退症患者发生肾结石和肾钙质沉着症的风险。
这是一项在美国使用管理式医疗索赔数据库进行的回顾性队列研究，时间范围为 2007 年 1 月至 2017 年 6 月。纳入的患者为患有慢性甲状旁腺功能减退症（不包括接受甲状旁腺激素治疗的患者）且在最长 5 年的随访期间随机选择的无甲状旁腺功能减退症的患者。主要结局指标是肾结石，通过肾结石的诊断代码或手术代码来识别；肾钙质沉着症，通过诊断代码识别。
肾结石分析包括 8097 名患有甲状旁腺功能减退症的成年患者和 40485 名没有甲状旁腺功能减退症的成年患者。排除基线时有肾钙质沉着症诊断的患者后，肾钙质沉着症分析包括 8051 名患有甲状旁腺功能减退症的患者和 40466 名没有甲状旁腺功能减退症的患者。在 5 年的随访期间，Kaplan-Meier 分析显示与没有甲状旁腺功能减退症的患者相比，慢性甲状旁腺功能减退症患者肾结石和肾钙质沉着症的风险显著增加（均 P<0.001）。在调整后的分析中，慢性甲状旁腺功能减退症与肾结石（风险比 [HR]，1.81；95%置信区间 [CI]，1.60-2.04）和肾钙质沉着症（HR，6.94；95% CI，4.41-10.92）的风险增加相关。一项仅限于至少进行一次肾脏影像学检查的患者的敏感性分析显示，患有甲状旁腺功能减退症的患者中有 2.6%（n=59）和未患有甲状旁腺功能减退症的患者中有 0.5%（n=20）（比值，5.5；P<0.001）发生了肾钙质沉着症。
这项大型回顾性队列研究表明，与没有慢性甲状旁腺功能减退症的患者相比，患有慢性甲状旁腺功能减退症的患者肾结石和肾钙质沉着症的风险显著增加，且具有统计学意义和临床意义。
