Parathyroidectomy Has No Effect on Preserving Kidney Function in Older Adults With Hyperparathyroidism
In a recent study, researchers found that parathyroidectomy had no effect on long-term kidney function in older adults with hyperparathyroidism (PHPT).
A common endocrine disorder, PHPT is associated with an increased risk for chronic kidney disease (CKD) and current multidisciplinary guidelines recommend parathyroidectomy to slow the progression of PHPT to CKD. Researchers aimed to determine the procedure's long-term effects on kidney function.
To determine the effectiveness of the procedure, the researchers compared the incidence of a sustained decline in estimated glomerular filtration rate (eGFR) of at least 50% in patients with PHPT treated with parathyroidectomy vs patients who did not receive the operation.
The researchers conducted their study using observational data from 43,697 patients with PHPT. Of the total, 2928 had a decline of at least 50% in eGFR over median follow-up period of 4.9 years. The weighted cumulative incidence of eGFR in patients managed with parathyroidectomy was 5.1% at 5 years and 10.8% at 10 years. Comparatively, patients who were nonoperatively managed had a cumulative incidence of eGFR decline of 5.1% at 5 years and 12.0% at 10 years.
Additionally, in subgroup analyses, the researchers found no heterogeneity of treatment effect based on pretreatment kidney function.
However, parathyroidectomy may reduce the hazard of kidney function in patients aged 60 years and younger.
“Parathyroidectomy had no effect on long-term kidney function in older adults with PHPT,” the researchers concluded. “Potential benefits related to kidney function should not be the primary consideration for PHPT treatment decisions.”
The researchers noted that their study had several limitations, most notably that their analyses were done in a predominately male cohort.
Reference:
Seib CD, Ganesan C, Furst A, et al. Estimated effect of parathyroidectomy on long-term kidney function in adults with primary hyperparathyroidism. Ann Intern Med. Published online April 11, 2023. doi:10.7326/M22-2222