Parathyroidectomy versus cinacalcet for the correction of secondary hyperparathyroidism in hemodialysis patients

Secondary hyperparathyroidism (sHPT) is one of the most common abnormalities in patients with chronic kidney disease, and is characterized by parathyroid gland hyperplasia and increased plasma levels of parathyroid hormone (PTH). This condition results in disturbances in vitamin D, phosphorus, calcium and PTH metabolism and bone disorders and has been associated with cardiovascular complications increased mortality. Elevation of PTH higher than 300-450 pg/ml is associated with an increased all-cause mortality.
Since the introduction of Cinacalcet in 2004 the drug has changed global prescription patterns dramatically which shifted from surgery to dominantly medical treatment. However, cinacalcet has never been systematically compared with with (sub) total parathyroidectomy (PTx) and it has side effects (evolve trial 2012) is expensive and postpones definite treatment leading to morbidity.

Therefore the multicentre Rhino trial was initiated comparing PTx versus Cinacalcet.

Total parathyroidectomy (PTX) in patients with secondary hyperparathyroidism (HPT2) is a more effective treatment than the use of Calcimimetica.

first interim-analysis after one year, follow up in study two years.

Total parathyroidectomy with transplantation versus the use of Cinacalcet