Geographic variation of parathyroidectomy in patients receiving hemodialysis: A retrospective cohort analysis

James B. Wetmore, Jiannong Liu, Paul J. Dluzniewski, Areef Ishani, Geoffrey A. Block, Allan J. Collins

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Background: Secondary hyperparathyroidism (SHPT) is associated with adverse outcomes in patients receiving maintenance dialysis. Parathyroidectomy is a treatment for SHPT; whether parathyroidectomy utilization varies geographically in the US is unknown. Methods: A retrospective cohort analysis was undertaken to identify all patients aged 18 years or older who were receiving in-center hemodialysis between 2007 and 2009, were covered by Medicare Parts A and B, and had been receiving hemodialysis for at least 1 year. Parathyroidectomy was identified from inpatient claims using relevant International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes. Patient characteristics and End-Stage Renal Disease Network (a proxy for geography) were ascertained. Adjusted odds ratios for parathyroidectomy were estimated from a logistic model. Results: A total of 286,569 patients satisfied inclusion criteria, of whom 4435 (1.5%) underwent PTX. After adjustment for a variety of patient characteristics, there was a 2-fold difference in adjusted odds of parathyroidectomy between the most- and least-frequently performing regions. Adjusted odds ratios were more than 20% higher than average in four networks, and more than 20% lower in four networks. Conclusions: Parathyroidectomy use varies substantially by geography in the US; the factors responsible should be further investigated.

Original languageEnglish (US)
Article number77
JournalBMC Surgery
Issue number1
StatePublished - Nov 29 2016

Bibliographical note

Publisher Copyright:
© 2016 The Author(s).


  • Dialysis
  • End-stage renal disease
  • Mineral metabolism
  • Parathyroidectomy
  • Secondary hyperparathyroidism


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