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Effects of parathyroidectomy on kidney function in patients with primary hyperparathyroidism: Results of a prospective study

Published:September 24, 2022DOI:https://doi.org/10.1016/j.surg.2022.05.038

      Abstract

      Background

      Altered glomerular filtration rate is a controversial indication for parathyroidectomy in patients with primary hyperparathyroidism. The objective of this study was to evaluate the estimated glomerular filtration rate change 12 months after parathyroidectomy for primary hyperparathyroidism according to preoperative kidney function.

      Method

      Patients who underwent parathyroidectomy for primary hyperparathyroidism between 2016 and 2021 (n = 381) were enrolled in a monocentric prospective cohort. Patients without 1-year follow-up or with missing data were excluded (n = 135, 35%). Patients were dichotomized according to their baseline estimated glomerular filtration rate: <60 mL/min (group 1) and ≥60 mL/min (group 2). Parameters were measured before and then at 6 and 12 months after parathyroidectomy.

      Results

      Out of 246 included patients, 27 (11%) were assigned to group 1 and 219 (89%) to group 2. The mean baseline estimated glomerular filtration rate was 46.8 ± 11.5 and 87.3 ± 14.7 mL/min in groups 1 and 2, respectively. Group 1 patients were older (P = .0006) and had a higher median serum parathyroid hormone level (P = .021). At 6 months postoperative, 224 patients (91%) were normocalcemic. The estimated glomerular filtration rate raw change after parathyroidectomy was significantly higher in group 1 than in group 2 (4.2 ± 7.8 vs -2.2 ± 9.1 mL/min, P = .0004). In group 1, 13/27 patients (48%) improved their chronic kidney disease stage after parathyroidectomy, including 6/13 (46%) with postoperative estimated glomerular filtration rate ≥60 mL/min, whereas 2/27 (7%) worsened. The baseline estimated glomerular filtration rate <60 mL/min and elevated serum calcium level were associated with postoperative estimated glomerular filtration rate improvement in multivariable analysis (P = .0023 and .039, respectively).

      Conclusion

      Parathyroidectomy for primary hyperparathyroidism is more likely to improve kidney function in patients with preoperative estimated glomerular filtration rate <60 mL/min. These results strengthen the current guidelines for surgery.
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      References

        • Gopinath P.
        • Mihai R.
        Hyperparathyroidism. Surgery. 2011; 29: 451e8
        • Applewhite M.K.
        • Schneider D.F.
        Mild primary hyperparathyroidism: a literature review.
        Oncologist. 2014; 19: 919-929
        • Verdelli C.
        • Corbetta S.
        Mechanisms in endocrinology: kidney involvement in patients with primary hyperparathyroidism: an update on clinical and molecular aspects.
        Eur J Endocrinol. 2017; 176: R39-R52
        • Yu N.
        • Donnan P.T.
        • Flynn R.W.
        • et al.
        Increased mortality and morbidity in mild primary hyperparathyroid patients.
        Clin Endocrinol (Oxf). 2010; 73: 30-34
        • Yu N.
        • Donnan P.T.
        • Leese G.P.
        A record linkage study of outcomes in patients with mild primary hyperparathyroidism: the Parathyroid Epidemiology and Audit Research Study (PEARS): outcomes of mild PHPT.
        Clin Endocrinol (Oxf). 2011; 75: 169-176
        • Bilezikian J.P.
        • Brandi M.L.
        • Eastell R.
        • et al.
        Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the Fourth International Workshop.
        J Clin Endocrinol Metab. 2014; 99: 3561-3569
        • Bollerslev J.
        • Jansson S.
        • Mollerup C.L.
        • et al.
        Medical observation, compared with parathyroidectomy, for asymptomatic primary hyperparathyroidism: a prospective, randomized trial.
        J Clin Endocrinol Metab. 2007; 92: 1687-1692
        • Rao D.S.
        • Phillips E.R.
        • Divine G.W.
        • Talpos G.B.
        Randomized controlled clinical trial of surgery versus no surgery in patients with mild asymptomatic primary hyperparathyroidism.
        J Clin Endocrinol Metab. 2004; 89: 5415-5422
        • Ambrogini E.
        • Cetani F.
        • Cianferotti L.
        • et al.
        Surgery or surveillance for mild asymptomatic primary hyperparathyroidism: a prospective, randomized clinical trial.
        J Clin Endocrinol Metab. 2007; 92: 3114-3121
        • Tassone F.
        • Guarnieri A.
        • Castellano E.
        • Baffoni C.
        • Attanasio R.
        • Borretta G.
        Parathyroidectomy halts the deterioration of renal function in primary hyperparathyroidism.
        J Clin Endocrinol Metab. 2015; 100: 3069-3073
        • Çalişkan M.
        • Kizilgül M.
        • Beysel S.
        • et al.
        Factors associated with glomerular filtration rate variation in primary hyperparathyroidism after parathyroidectomy.
        Turk J Med Sci. 2019; 49: 295-300
        • Belli M.
        • Martin R.M.
        • Brescia M.D.G.
        • et al.
        Acute and long-term kidney function after parathyroidectomy for primary hyperparathyroidism.
        PLoS One. 2020; 15e0244162
        • Trébouet E.
        • Bannani S.
        • Wargny M.
        • et al.
        Mild sporadic primary hyperparathyroidism: high rate of multiglandular disease is associated with lower surgical cure rate.
        Langenbecks Arch Surg. 2019; 404: 431-438
        • Bannani S.
        • Christou N.
        • Guérin C.
        • et al.
        Effect of parathyroidectomy on quality of life and non-specific symptoms in normocalcaemic primary hyperparathyroidism.
        Br J Surg. 2018; 105: 223-229
        • Levey A.S.
        • Eckardt K.-U.
        • Dorman N.M.
        • et al.
        Nomenclature for kidney function and disease: report of a Kidney Disease: Improving Global Outcomes (KDIGO) Consensus Conference.
        Kidney Int. 2020; 97: 1117-1129
        • Hendrickson C.D.
        • Castro Pereira D.J.
        • Comi R.J.
        Renal impairment as a surgical indication in primary hyperparathyroidism: do the data support this recommendation?.
        J Clin Endocrinol Metab. 2014; 99: 2646-2650
        • Corbetta S.
        • Eller-Vainicher C.
        • Vicentini L.
        • et al.
        High prevalence of simple kidney cysts in patients with primary hyperparathyroidism.
        J Endocrinol Invest. 2009; 32: 690-694
        • Frey S.
        • Mirallié É.
        • Cariou B.
        • Blanchard C.
        Impact of parathyroidectomy on cardiovascular risk in primary hyperparathyroidism: a narrative review.
        Nutr Metab Cardiovasc Dis. 2021; 31: 981-996
        • Wu M.
        • Tang R.N.
        • Liu H.
        • Ma K.L.
        • Lv L.L.
        • Liu B.C.
        Nuclear translocation of β-catenin mediates the parathyroid hormone-induced endothelial-to-mesenchymal transition in human renal glomerular endothelial cells.
        J Cell Biochem. 2014; 115: 1692-1701
        • Nair C.G.
        • Babu M.
        • Jacob P.
        • Menon R.
        • Mathew J.
        • Unnikrishnan
        Renal dysfunction in primary hyperparathyroidism; effect of parathyroidectomy: a retrospective cohort study.
        Int J Surg. 2016; 36: 383-387
        • Gianotti L.
        • Tassone F.
        • Cesario F.
        • et al.
        A slight decrease in renal function further impairs bone mineral density in primary hyperparathyroidism.
        J Clin Endocrinol Metab. 2006; 91: 3011-3016
        • Tassone F.
        • Gianotti L.
        • Emmolo I.
        • Ghio M.
        • Borretta G.
        Glomerular filtration rate and parathyroid hormone secretion in primary hyperparathyroidism.
        J Clin Endocrinol Metab. 2009; 94: 4458-4461
        • Yeh M.W.
        • Wiseman J.E.
        • Ituarte P.H.
        • et al.
        Surgery for primary hyperparathyroidism: are the consensus guidelines being followed?.
        Ann Surg. 2012; 255: 1179-1183
        • Liang C.-C.
        • Yeh H.-C.
        • Lo Y.-C.
        • et al.
        Parathyroidectomy slows renal function decline in patients with primary hyperparathyroidism.
        J Endocrinol Invest. 2021; 44: 755-763
        • Hedbäck G.
        • Abrahamsson K.
        • Odén A.
        The improvement of renal concentration capacity after surgery for primary hyperparathyroidism.
        Eur J Clin Invest. 2001; 31: 1048-1053
        • Kristoffersson A.
        • Backman C.
        • Granqvist K.
        • Järhult J.
        Pre- and postoperative evaluation of renal function with five different tests in patients with primary hyperparathyroidism.
        J Intern Med. 1990; 227: 317-324
        • Egan R.J.
        • Dewi F.
        • Arkell R.
        • et al.
        Does elective parathyroidectomy for primary hyperparathyroidism affect renal function? A prospective cohort study.
        Int J Surg. 2016; 27: 138-141
        • Schwarz A.
        • Rustien G.
        • Merkel S.
        • Radermacher J.
        • Haller H.
        Decreased renal transplant function after parathyroidectomy.
        Nephrol Dial Transplant. 2006; 22: 584-591
        • Chudzinski W.
        • Wyrzykowska M.
        • Nazarewski S.
        • Durlik M.
        • Galazka Z.
        Does the parathyroidectomy endanger the transplanted kidney?.
        Transplant Proc. 2016; 48: 1633-1636