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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Article info
Publication history
Published online: September 24, 2022
Accepted:
May 20,
2022
Footnotes
This work has been presented orally during the American Association of Endocrine Surgeons (AAES) meeting in Cleveland, OH, on May 23, 2022.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
