Researchers studied two ways to treat a serious condition that affects people with kidney disease. Some patients had surgery to remove problematic glands, while others took a medication called cinacalcet. After following patients for about 4 years, those who had surgery lived longer and had fewer heart problems than those who took the medication. This suggests that surgery might be a better long-term choice for some kidney patients, even though the medication is used more often today. The findings could help doctors decide which treatment works best for each patient.
The Quick Take
- What they studied: Whether surgery to remove overactive glands works better than taking a medication to control those glands in people with kidney disease
- Who participated: Over 11,500 patients with kidney disease who had overactive parathyroid glands. After careful matching, 2,454 patients were compared—1,227 who had surgery and 1,227 who took the medication cinacalcet
- Key finding: Patients who had surgery were 32% less likely to die and 25% less likely to have heart problems over 4 years compared to those taking medication
- What it means for you: If you have kidney disease with overactive parathyroid glands, surgery might offer better long-term protection for your heart and life expectancy than medication alone. However, this doesn’t mean surgery is right for everyone—talk with your doctor about your specific situation
The Research Details
Researchers looked back at medical records from 2004 to 2025 for patients with kidney disease who had overactive parathyroid glands. They compared two groups: people who had surgery to remove the glands and people who took a medication called cinacalcet for at least 6 months. To make the comparison fair, they used a special statistical method called propensity score matching. This technique selected patients from each group who were similar in age, health conditions, and other treatments they were receiving. This way, any differences in outcomes would more likely be due to the treatment choice rather than other factors.
The researchers then tracked both groups for about 4 years on average, recording who died and who had heart problems like heart attacks, heart failure, or irregular heartbeats. They used statistical models to calculate how much more or less likely each group was to experience these problems.
This approach is called a retrospective study because researchers looked backward at records that already existed, rather than randomly assigning patients to treatments. While this type of study can’t prove one treatment causes better outcomes, it can show strong associations between treatment and results.
This research matters because kidney disease patients with overactive parathyroid glands face serious health risks. Doctors have been using medication more often in recent years instead of surgery, but we didn’t have clear evidence about which approach keeps patients healthier long-term. This study provides real-world evidence from thousands of patients over many years, which helps doctors make better treatment decisions.
Strengths: The study included a large number of patients (over 11,000) followed for several years, which provides reliable information. The researchers used propensity score matching to make the two groups as similar as possible before comparing them, which reduces bias. Limitations: This was a retrospective study using existing medical records, so doctors may have chosen surgery for healthier patients or medication for sicker ones, which could affect results even with matching. The study didn’t randomly assign patients to treatments, so we can’t be completely certain surgery caused the better outcomes. Some patients may have switched treatments during the study, which wasn’t fully accounted for.
What the Results Show
Over the 4-year follow-up period, patients who had surgery had significantly better outcomes. The death rate was 32% lower in the surgery group compared to the medication group. When researchers looked at heart problems as a group, surgery patients had 25% fewer complications. When broken down by specific heart problems, surgery patients had lower rates of heart attacks (ischemic heart disease), heart failure, and irregular heartbeats (arrhythmias).
Interestingly, these benefits held true even when researchers looked only at patients whose parathyroid hormone levels were moderately elevated (not extremely high). In this subgroup, surgery patients still had 27% lower death rates and 38% lower heart problem rates. This suggests that surgery might help a broader range of patients than previously thought, not just those with the most severe cases.
The study also noted that while cinacalcet medication has become more commonly used in recent years, the long-term outcomes with surgery appear superior. This finding is important because it suggests the shift toward medication use may not be giving patients the best long-term results.
The study found that the benefits of surgery were consistent across different types of heart problems. Patients who had surgery had lower risks of developing each type of heart condition separately, not just when all heart problems were combined. This suggests surgery provides broad cardiovascular protection rather than helping with just one specific type of heart disease. The researchers also noted that the benefits persisted throughout the entire follow-up period, indicating these weren’t just short-term advantages.
Previous research has shown that overactive parathyroid glands in kidney disease patients increase heart disease risk. Earlier studies suggested that controlling parathyroid hormone levels was important, but there wasn’t clear evidence about which method—surgery or medication—worked better long-term. Some older research favored surgery, but the adoption of cinacalcet medication led many doctors to choose medication instead. This new study provides the most comprehensive long-term comparison to date and suggests that earlier research favoring surgery may have been correct.
The biggest limitation is that this wasn’t a randomized controlled trial where patients were randomly assigned to surgery or medication. Doctors chose the treatment based on individual patient factors, which means healthier patients might have been more likely to have surgery. Even though researchers used statistical matching to address this, some unmeasured differences between groups could remain. Additionally, the study relied on medical records that weren’t created for research purposes, so some important information might be missing. The study also couldn’t account for patients who switched treatments during the follow-up period or didn’t stick with their assigned treatment. Finally, the results may not apply equally to all populations, as the study used data from a specific healthcare system.
The Bottom Line
For patients with kidney disease and overactive parathyroid glands: Surgery appears to offer better long-term survival and heart protection than medication alone (moderate to high confidence based on this large study). However, surgery carries risks and recovery time, so it’s not appropriate for everyone. Have a detailed conversation with your kidney specialist and surgeon about whether surgery makes sense for your specific situation, considering your age, overall health, and other medical conditions. If you’re currently taking cinacalcet, don’t stop without talking to your doctor, but ask whether surgery might be worth considering.
This research is most relevant for: Adults with kidney disease (especially those on dialysis) who have overactive parathyroid glands and are considering treatment options. Kidney specialists and surgeons who treat these patients. People with kidney disease who want to understand their long-term health risks. This research is less relevant for: People with normal kidney function. Those with primary hyperparathyroidism (a different condition). Patients who cannot safely have surgery due to severe health problems.
The benefits of surgery appear to develop gradually over months and years. In this study, researchers followed patients for an average of 4 years and saw clear differences by that point. You shouldn’t expect immediate improvements after surgery—recovery takes weeks to months, and the cardiovascular benefits build over time. If you’re considering surgery, discuss realistic timelines with your surgical team.
Want to Apply This Research?
- Track monthly blood pressure readings and note any new symptoms like shortness of breath, chest discomfort, or irregular heartbeats. If you’ve had surgery, also track parathyroid hormone levels at each lab visit to monitor how well the surgery controlled the problem.
- If considering treatment options: Schedule a consultation with both your kidney specialist and a surgeon experienced in parathyroid surgery to discuss pros and cons. If already on cinacalcet: Ask your doctor at your next visit whether surgery might be appropriate for you. If post-surgery: Attend all follow-up appointments and lab work to ensure the surgery achieved its goals.
- Set monthly reminders to check blood pressure and record any heart-related symptoms. Track parathyroid hormone levels, calcium, and phosphorus at each lab visit (usually every 1-3 months). Note any new or worsening symptoms like fatigue, shortness of breath, or heart palpitations. Share this information with your kidney doctor at each visit to assess whether your current treatment is working well.
This research suggests surgery may offer benefits for certain kidney disease patients, but individual results vary. Surgery carries risks including infection, bleeding, and low calcium levels after the procedure. Do not make treatment decisions based on this article alone. Always consult with your nephrologist (kidney specialist) and surgeon to discuss whether surgery or medication is appropriate for your specific medical situation. This article is for educational purposes and does not replace professional medical advice. If you have kidney disease and overactive parathyroid glands, work with your healthcare team to develop a personalized treatment plan based on your complete medical history and current health status.