Introduction: This is the first study comparing the effectiveness of “medical” with surgical parathyroidectomy in the management of hyperparathyroidism secondary to end stage renal failure (ESRF). Traditionally surgery was the treatment of choice. More recently the National Institute of Clinical Excellence (NICE) has approved medical therapy with calcimimetics to treat excess parathyroid hormone (PTH) production. Calcimimetics inhibit PTH secretion by increasing the sensitivity of parathyroid cells’ calcium-sensing receptors to extracellular calcium. The aim of this study was to determine whether the calcimimetic, cinacalcet should replace surgery in managing secondary hyperparathyroidism (2HPTH) in patients with ESRF.

Method: Fifty four patients with 2HPTH resistant to optimal conventional medical management were studied. Twenty patients were treated with surgical parathyroidectomy and 34 patients with cinacalcet. Serum PTH and bone profile was measured before and at monthly intervals after intervention.

Results: Pre-treatment PTH, calcium (Ca), phosphate (P), Ca × P product and alkaline phosphatase (ALP) were comparable. In all 20 surgical patients the 1 week post operative PTH was normal. In the medical cohort after 4 months of daily cinacalcet the PTH declined by 48% ( p < 0.001) but never dropped to normal levels. In both cohorts this reduction was maintained at 18 months. In all but 1 surgical patient ALP declined to normal levels whereas on cinacalcet there was no statistically significant reduction.

Conclusions: Surgery is superior to “medical” parathyroidectomy in controlling PTH and ALP.

Conflict of interest: None.