Secondary Hyperparathyroidism Is Associated with Higher Cost of Care among Chronic Kidney Disease Patients with Cardiovascular Comorbidities

Abstract

Background: Chronic kidney disease (CKD) is associated with high morbidity and mortality, and incurs a substantial cost. Secondary hyperparathyroidism (SHPT) is a major complication associated with CKD and has been linked with cardiovascular disease, leading to poor outcomes. Methods: We analyzed retrospective studies for the prevalence of congestive heart failure (CHF) and acute myocardial infarction/ischemic heart disease (AMI/IHD) in pre-dialysis CKD patients to estimate the additional hospitalization cost incurred secondary to high parathyroid hormone (PTH) levels. Two models were developed to estimate the contribution of elevated PTH levels towards hospitalization costs in CKD patients with CHF and AMI/IHD. Results: Cost contributions were estimated for the time intervals relative to initiation of dialysis, with the largest contributions estimated for the 3- to 1-month period prior to initiation of dialysis, USD 205.24 per patient-month at risk for CHF and USD 69.44–111.75 per patient-month at risk for AMI/IHD, without and with major complications, respectively. Conclusion: Higher PTH levels are associated with a high prevalence of CHF and AMI/IHD. Our cost analyses show that elevated PTH levels contribute significantly toward the overall cost of care among CKD patients with CHF and AMI/IHD. The contribution of elevated PTH levels toward hospitalization cost is highest during the months directly leading up to initiation of dialysis. Further studies are required to evaluate the relationship between hyperparathyroidism and cardiovascular disease, and its impact on economic outcomes.

Impact of mineral and bone disorder on healthcare resource use and associated costs in the European Fresenius medical care dialysis population: a retrospective cohort study

“…As noted above, studies in CKD patients in the US by Schumock et al [17] and Khan et al [18] have previously shown that SHPT can substantially increase healthcare costs. Results of these US studies are not directly comparable to ours due to patients’ different CKD stages at baseline and the focus on patients with diabetes by Schumock et al [17] and on those with CVD by Khan et al [18].…”

“…Total healthcare costs were 320% higher in diabetic CKD patients with SHPT compared with those without SHPT [17]. Khan et al [18] estimated the cost contribution of elevated iPTH levels in CKD patients in the US with congestive heart failure (CHF), all in stages prior to ESRD at baseline. Patients with iPTH ≥ 65 pg/mL had US$205 higher mean monthly CHF-related hospitalisation costs (in 2005 US$) in the period 1 to 3 months preceding dialysis compared with patients with iPTH < 65 pg/mL (below the upper bound of the K/DOQI target range for patients with Stage 3 CKD: 35–70 pg/mL [5]).…”

Secondary Hyperparathyroidism Is Associated with Increased Risk of Hospitalization or Death in Elderly Adults Living in a Geriatric Institution

“…To our knowledge, our study is the first to evaluate the association of secondary hyperparathyroidism with hospitalization. The association of secondary hyperparathyroidism with mortality is well established in chronic renal failure patients [15][16][17][18][19] . A previous Australian study conducted with institutionalized elderly adults living in geriatric institutions and clinics also showed the 1 The GFR was calculated using the Cockcroft-Gault equation [25].…”

“…What we do not know is whether the correction of secondary hyperparathyroidism by supplementing calcium and vitamin D would prevent hospitalization. In patients with chronic renal failure, the decrease in serum PTH levels improves the prognosis of the patients, and the correction of hyperparathyroidism associated with vitamin D deficiency reduces the number of falls and fractures [15,16] . These data suggest that the reduction in serum PTH levels, possibly below 48 pg/ml, may have an impact on the health of the elderly population.…”

“…The association of secondary hyperparathyroidism with systemic arterial hypertension [11] and metabolic syndrome [12] has recently been documented. In chronic renal failure patients, secondary hyperparathyroidism is a major risk factor for cardiovascular diseases [13,14] , hospitalization [15,16] as well as cardiovascular and total mortality [17][18][19] . A study conducted with elderly adults in Australia found an association between secondary hyperparathyroidism and mortality regardless of the levels of serum creatinine and 25-hydroxyvitamin D [25(OH)D] levels [20] .…”