Analysis of Primary Hyperparathyroidism Screening Among US Veterans With Kidney Stones

Abstract

IMPORTANCE Approximately 3% to 5% of patients with kidney stones have primary hyperparathyroidism (PHPT), a treatable cause of recurrent stones. However, the rate of screening for PHPT in patients with kidney stones remains unknown.OBJECTIVES To estimate the prevalence of parathyroid hormone (PTH) testing in veterans with kidney stones and hypercalcemia and to identify the demographic, geographic, and clinical characteristics of veterans who were more or less likely to receive PTH testing. DESIGN, SETTING, AND PARTICIPANTSThis cohort study obtained Veterans Health Administration (VHA) health records from the Corporate Data Warehouse for veterans who received care in 1 of the 130 VHA facilities across the United States from January 1, 2008, through December 31, 2013. Historical encounters, medical codes, and laboratory data were assessed. Included patients had diagnostic or procedural codes for kidney or ureteral stones, and excluded patients were those with a previous serum

Utility of blood tests in screening for metabolic disorders in kidney stone disease

“…This study assessed the clinical value of undertaking blood tests to screen for metabolic disorders in patients presenting with kidney stones. Primary hyperparathyroidism has been reported in 0.5-5% of the stone-forming population [8][9][10].…”

“…In the UK, the National Institute of Health and Care Excellence (NICE) recommends that adults presenting with ureteric or renal stones undergo metabolic screening with a serum calcium blood test alone [6]; an elevated serum calcium level may indicate previously unrecognized hyperparathyroidism, granulomatous disease or malignancy [5]. The NICE committee was unable to identify any evidence to inform recommendations for metabolic blood tests in patients with kidney stones, but made note of the high prevalence of primary hyperparathyroidism in these individuals and the low cost of serum calcium testing [6,[8][9][10]. In addition to serum calcium, the European Association of Urology (EAU) recommends that serum urate is checked routinely in emergency urolithiasis patients [5].…”

Frequency of Parathyroid Hormone Assessment in the Evaluation of Hypercalcemia. A Comparison Between Patients With and Without a History of Malignancy in a 20-year Dataset of 20,954 Patients

“…Despite a simple means with which to diagnose primary hyperparathyroidism, for various reasons, this is a diagnosis that is often overlooked by lack of and/or incorrect interpretation of biochemical testing. [12][13][14][15][16][17] Multiple studies have shown that only approximately 30% of patients with documented hypercalcemia have ever had a PTH level assessed. [12][13][14][15][16][17] However, the frequency range at different facilities described in a single study varied widely from as low as 4% to as high as 57%.…”

“…[12][13][14][15][16][17] Multiple studies have shown that only approximately 30% of patients with documented hypercalcemia have ever had a PTH level assessed. [12][13][14][15][16][17] However, the frequency range at different facilities described in a single study varied widely from as low as 4% to as high as 57%. 16 Hypercalcemia of malignancy (HCM) is an important complication of malignancy, most often seen in advanced stages of the clinical course of a patient.…”

“…[12][13][14][15][16][17] However, the frequency range at different facilities described in a single study varied widely from as low as 4% to as high as 57%. 16 Hypercalcemia of malignancy (HCM) is an important complication of malignancy, most often seen in advanced stages of the clinical course of a patient. Estimates of its frequency appear to be decreasing, recent studies suggesting a prevalence on the order of 0.67% to 2.0%, 18,19 while older studies suggest a higher prevalence of between 20% and 30%.…”