Five-year Estimated Glomerular Filtration Rate in Patients With Hypoparathyroidism Treated With and Without rhPTH(1-84)

Kristina S Chen, Elvira O Gosmanova, Gary C Curhan, Markus Ketteler, Mishaela Rubin, Elyse Swallow, Jing Zhao, Jessie Wang, Nicole Sherry, Alan Krasner, John P Bilezikian, Kristina S Chen, Elvira O Gosmanova, Gary C Curhan, Markus Ketteler, Mishaela Rubin, Elyse Swallow, Jing Zhao, Jessie Wang, Nicole Sherry, Alan Krasner, John P Bilezikian

Abstract

Context: Chronic hypoparathyroidism (HypoPT) is conventionally managed with oral calcium and active vitamin D. Recombinant human parathyroid hormone (1-84) (rhPTH[1-84]) is a therapy targeting the pathophysiology of HypoPT by replacing parathyroid hormone.

Objective: To compare changes in the estimated glomerular filtration rate (eGFR) in patients with chronic HypoPT receiving or not receiving rhPTH(1-84) during a 5-year period.

Design/setting: A retrospective analysis of patients with chronic HypoPT treated with or without rhPTH(1-84).

Patients: Sixty-nine patients with chronic HypoPT from 4 open-label, long-term trials (NCT00732615, NCT01268098, NCT01297309, and NCT02910466) composed the rhPTH(1-84) cohort and 53 patients with chronic HypoPT not receiving rhPTH(1-84) from the Geisinger Healthcare Database (01/2004-06/2016) composed the historical control cohort.

Interventions: The rhPTH(1-84) cohort (N = 69) received rhPTH(1-84) therapy; the historical control cohort (N = 53) did not receive rhPTH(1-84).

Main outcome measures: Changes in eGFR from baseline during a 5-year follow-up were examined in multivariate regression analyses.

Results: At baseline, demographic characteristics and eGFR were similar between cohorts, though the proportions with diabetes and cardiac disorders were lower in the rhPTH(1-84) cohort. At the end of follow-up, mean eGFR increased by 2.8 mL/min/1.73 m2 in the rhPTH(1-84) cohort, while mean eGFR fell by 8.0 mL/min/1.73 m2 in the control cohort. In the adjusted model, the difference in the annual eGFR change between the rhPTH(1-84) cohort and the control cohort was 1.7 mL/min/1.73 m2 per year (P = 0.009).

Conclusions: Estimated glomerular filtration rate was preserved for over 5 years among patients with chronic HypoPT receiving rhPTH(1-84) treatment, contrasting with an eGFR decline among those not receiving rhPTH(1-84).

Keywords: chronic hypoparathyroidism; kidney function; recombinant human parathyroid hormone (1-84); retrospective study.

© Endocrine Society 2020.

Figures

Figure 1.
Figure 1.
Sample selection of the historical control cohort. Abbreviations: eGFR, estimated glomerular filtration rate; HPT, hypoparathyroidism; rhPTH, recombinant human parathyroid hormone.
Figure 2.
Figure 2.
eGFR change from baseline based on the unadjusted regression model.a Abbreviations: eGFR, estimated glomerular filtration rate; rhPTH, recombinant human parathyroid hormone. a The shaded areas around the lines indicate confidence intervals.
Figure 3.
Figure 3.
eGFR change from Year 1 to Year 5 based on an adjusted regression model. Abbreviations: eGFR, estimated glomerular filtration rate; rhPTH, recombinant human parathyroid hormone.

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Source: PubMed

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