Parathyroidectomy may preserve renal function in some patients with hyperparathyroidism

Important points:

• Overall, parathyroidectomy did not affect long-term renal function in older adults with primary hyperparathyroidism
• However, early implementation may preserve function in patients younger than 60 years.

Although parathyroidectomy had no significant effect on long-term renal function in older adults with primary hyperparathyroidism, the researchers found that if performed early, it could reduce function may be maintained.

Primary hyperparathyroidism (PHPT) is a common endocrine disorder and is associated with an increased risk of chronic kidney disease (CKD). Carolyn D. CebuMD, MAS, Written by an assistant professor of surgery at Stanford Medicine and a colleague Annals of internal medicineTo slow the progression of CKD, multidisciplinary guidelines recommend surgical removal of abnormal parathyroid glands — parathyroidectomy — For patients with PHPT and estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m².

However, data on the association of long-term renal function and parathyroidectomy are limited.

“Most patients with PHPT, including those who meet surgical guideline criteria based on the stage of CKD, are not treated with parathyroidectomy. “It highlights the clinical uncertainty regarding the efficacy of

Seib et al. therefore conducted a study comparing the incidence of a sustained decline of at least 50% in eGFR in PHTP patients who underwent parathyroidectomy with non-operative management.

“We found that parathyroidectomy was associated with a lower rate of sustained declines in eGFR of ≥50% after considering differences in baseline severity of PHPT and CKD risk factors between the operated and non-operated groups. ,” they wrote.

Researchers emulated a hypothetical randomized trial (targeted trial) by studying observational data from 43,697 adults diagnosed with PHTP.

Seib and colleagues found that for older people, Adult PHPT, parathyroidectomy They wrote that there was no significant effect on long-term renal function and that possible benefits related to renal function should not be the primary consideration in decisions about PHPT treatment.

With a median follow-up of 4.9 years, 6.7% of PHPT participants had at least a 50% reduction in eGFR. Regardless of how primary hyperparathyroidism was managed, the weighted cumulative incidence of eGFR decline was 5.1% at he 5 years.

At 10 years, the weighted cumulative incidence of eGFR decline was 10.8% in patients managed with parathyroidectomy. The reduction in non-surgically managed patients was 12%.

There was no significant difference in the adjusted hazards of eGFR decline between patients treated with parathyroidectomy and those treated with nonoperative management.

However, a subgroup analysis showed that patients <60 years of age were more likely to maintain long-term renal function when treated with early parathyroidectomy. In other words, parathyroidectomy was performed in patients younger than 60 years (HR = 0.75; 95% CI, 0.59-0.93) and in patients older than 60 years (HR = 1.08; 95% CI, 0.87-1.34).

Seib and colleagues write that their findings “enhance our understanding of the risks and benefits of parathyroidectomy for PHPT,” as well as “enhance our knowledge of appropriate indications for surgical management.”

“When participating in collaborative decision-making in older adults with PHPT, clinicians should not consider parathyroidectomy for its potential benefit of preserving renal function,” they wrote. “For young patients, clinicians should discuss the potential benefits of parathyroidectomy to reduce her risk of CKD and related complications in adults with PHPT.”