On 2015 Feb 02, NephJC - Nephrology Journal Club commented:

This study was discussed on Jan 20th and 21st in the open online nephrology journal club, #NephJC, on twitter.

Introductory comments are available at the NephJC website. The discussion was quite detailed, with more than 45 participants, including nephrologists, fellows and residents with great insight provided by participation of the first author, Areef Ishani.

A transcript and a curated (i.e. Storified) version of the tweetchat are available at the NephJC website.

The highlights of the tweetchat were:

• The authors have undertaken a meticulous and well conducted epidemiological study to explain the risks of parathyroidectomy in the dialysis population, with research funding from the manufacturer of cinacalcet (which is an alternative to surgical parathyroidectomy).

• There were concerns raised about the lack of matched controls who did not undergo surgery (especially given the contrasting result from the previous study using USRDS data, generalizability of the post surgical hospitalization data and the lack of long term follow up. However, this study does represent a solid estimate of the immediate and 1-year mortality following parathroidectomy in this population. The discussion, and the comments from the author, also helped to explain the steps taken and the reasons behind these design decisions.

• The final question of the optimal management of secondary hyperparathyroidism still remains unanswered. Opinion was widely divided on the ideal study: most likely a randomized trial of surgical versus medical treatment of uncontrolled secondary hyperparathyroidism with clinically relevant outcomes, but with possible comparator arms being calcimimetic therapy, surgical parathyroidectomy or even placebo, suggesting a lack of consensus.

Interested individuals can track and join in the conversation by following @NephJC or #NephJC, or visit the webpage at NephJC.com.

On 2015 Feb 02, NephJC - Nephrology Journal Club commented:

This study was discussed on Jan 20th and 21st in the open online nephrology journal club, #NephJC, on twitter.

Introductory comments are available at the NephJC website. The discussion was quite detailed, with more than 45 participants, including nephrologists, fellows and residents with great insight provided by participation of the first author, Areef Ishani.

A transcript and a curated (i.e. Storified) version of the tweetchat are available at the NephJC website.

The highlights of the tweetchat were:

• The authors have undertaken a meticulous and well conducted epidemiological study to explain the risks of parathyroidectomy in the dialysis population, with research funding from the manufacturer of cinacalcet (which is an alternative to surgical parathyroidectomy).

• There were concerns raised about the lack of matched controls who did not undergo surgery (especially given the contrasting result from the previous study using USRDS data, generalizability of the post surgical hospitalization data and the lack of long term follow up. However, this study does represent a solid estimate of the immediate and 1-year mortality following parathroidectomy in this population. The discussion, and the comments from the author, also helped to explain the steps taken and the reasons behind these design decisions.

• The final question of the optimal management of secondary hyperparathyroidism still remains unanswered. Opinion was widely divided on the ideal study: most likely a randomized trial of surgical versus medical treatment of uncontrolled secondary hyperparathyroidism with clinically relevant outcomes, but with possible comparator arms being calcimimetic therapy, surgical parathyroidectomy or even placebo, suggesting a lack of consensus.

Interested individuals can track and join in the conversation by following @NephJC or #NephJC, or visit the webpage at NephJC.com.