Does renal function improve after parathyroidectomy in primary hyperparathyroidism?

García-Martín, Florencio; Guadalix, Sonsoles; García-Boyano, Fernando; Peña, Natalia Melón; Pueyo, José Ignacio Martínez; Martínez, Ramiro Callejas; Terente, Manuel Praga

doi:10.1016/j.nefroe.2018.08.005

Cited by 5 publications

(6 citation statements)

References 36 publications

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“…Our results are in accordance with the ndings from two previous retrospectives studies by Tassone et al (5) and Garcia-Martin et al (17). In both studies, kidney function was assessed prior to and following PTX.…”

Section: Discussionsupporting

confidence: 93%

“…Most endocrinologists would expect that PTX, with removal of the hypercalciuric drive, would lead to some improvement in kidney function over conservative treatment. However, two recent studies suggested that surgical cure of pHPT is associated with an impaired kidney function in terms of a signi cantly decreased eGFR after PTX in patients with pre-operative eGFR >60 mL/min (5,17). The two studies followed relatively small study groups (n<300) and included only patients undergoing surgery (PTX) without studding changes in groups of patients not undergoing PTX.…”

Section: Introductionmentioning

confidence: 99%

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The Effect of Parathyroidectomy Compared to Non-Surgical Surveillance on Kidney Function in Primary Hyperparathyroidism: A Nationwide Historic Cohort Study

Matzen

Bislev

Sikjær

et al. 2021

Preprint

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Background: Patients with primary hyperparathyroidism (pHPT) and impaired kidney function (estimated glomerular filtration rate (eGFR) <60 mL/min) are offered parathyroidectomy (PTX) to protect them from further complications. Surprisingly, two recent uncontrolled cohort studies have suggested a further decrease in kidney function following PTX. We aimed to examine the effects of PTX compared to non-surgical surveillance on kidney function in pHPT patients.Methods: Historic cohort study. From the Danish National Patient Registry (NPR) and major medical biochemistry laboratories in Denmark, we identified 3585 patients with biochemically confirmed pHPT among whom n=1977 (55%) were treated with PTX (PTX-group) whereas n=1608 (45%) were followed without surgery (non-PTX group). Baseline was defined as time of diagnosis and kidney function was re-assessed 9-15 months after PTX (PTX group) or 9-15 months after diagnosis (non-PTX group).Results: At follow-up, eGFR had decreased significantly in the PTX- compared to the non-PTX-group (median -4% vs. -1%, p<0.01). Stratification by baseline eGFR showed that the decrease was significant for those with a baseline eGFR value of 80-89 and >90 mL/min, but not for those with lower eGFR values. Findings did not differ between patients with mild compared to moderate/severe hypercalcemia. However, after mutual adjustments, we identified baseline levels of calcium, PTH, and eGFR as well as age and treatment (PTX vs. no-PTX) as independent predictors for changes in kidney function.Conclusion: Compared to non-surgical surveillance, PTX is associated with a small but significant decrease in kidney function in pHPT patients with an initial normal kidney function.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

The Effect of Parathyroidectomy Compared to Non-Surgical Surveillance on Kidney Function in Primary Hyperparathyroidism: A Nationwide Historic Cohort Study

Matzen

Bislev

Sikjær

et al. 2021

Preprint

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“…Although renal impairment, defined as eGFR less than 60 mL/min/1.73 m 2 , has been regarded as an indication for surgery in PHPT patients, a previous review concluded that there is no evidence to suggest that surgical treatment with a PTX procedure has a significant impact on renal function in those patients [21]. On the other hand, several recent studies have reported that PTX results in worsened renal function, especially in PHPT patients with eGFR greater than 60 mL/min/1.73 m 2 [22][23][24] with the present study showing similar results. However, the mechanism why the patients with no renal impairment had a renal function deteriorated after PTX is still unclear.…”

Section: Discussionmentioning

confidence: 99%

Effects of denosumab as compared with parathyroidectomy regarding calcium, renal, and bone involvement in osteoporotic patients with primary hyperparathyroidism

et al. 2020

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Purpose: To evaluate the effects of denosumab (Dmb) on calcium, renal, and bone involvement in osteoporotic patients with primary hyperparathyroidism (PHPT) and compare with those who underwent a parathyroidectomy (PTX) procedure.Methods: This retrospective, longitudinal study included patients treated with Dmb (60 mg) once every 6 months (n=19) and those who successfully underwent a PTX procedure (n=19) Corrected calcium (cCa), eGFR, bone mineral density (BMD) in the lumbar spine (LS), total hip (TH), and 2 femoral neck (FN) and LS-trabecular bone score (TBS) changes at 1 year after beginning Dmb or undergoing PTX were measured.Result: Dmb group had older age, and showed milder disease activity and lower eGFR as compared to PTX group. In PTX group, cCa and eGFR were significantly decreased following surgery, while those were stable in Dmb group. There were significant increases in LS, TH, and FN-BMD in both Dmb (LS: 6.0±0.8%, TH: 3.7±1.0%, FN: 4.3±1.5%) and PTX (LS: 11.2±1.5%, TH: 7.5±1.5%, FN: 7.9±2.1%) groups. In Dmb group, LS-TBS was significantly improved by 3.0±1.0%, while TBS change in PTX group approached significance (2.8±1.5%). Percent change in TH-BMD was significantly correlated with baseline tartrate-resistant acid phosphatase-5b (TRACP-5b) in both groups.Conclusion: Dmb treatment not only increased BMD, dependent on bone turnover status, the same as PTX, but also improved LS-TBS. Additionally, it did not decrease the level of eGFR, whereas PTX did. These results suggest that Dmb treatment help in the clinical management of osteoporotic patients with PHPT who do not undergo surgery as alternative to PTX.

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“…Egan et al showed a significant reduction of eGFR at 1‐year follow‐up postparathyroidectomy compared to the baseline (73 ± 17 vs 78 ± 15 ml/min/1.73 m 2 ; P < .05) in PHPT patients 33 . A recent study done by Garcia‐Martin et al showed no significant change in the renal functions (creatinine and eGFR levels) in patients with renal manifestations, 34 whereas we reported a significant improvement in eGFR in patients with renal manifestations after parathyroidectomy.…”

Section: Discussionmentioning

confidence: 95%

A detailed appraisal of renal manifestations in primary hyperparathyroidism from Indian PHPT registry: Before and after curative parathyroidectomy

Agrawal

Arya

Sood

et al. 2020

Clinical Endocrinology

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Background Primary hyperparathyroidism (PHPT) is a systemic disorder characterized by hypercalcaemia and inappropriately elevated parathyroid hormone (PTH). Renal manifestations are one of the main presenting features both in symptomatic and asymptomatic PHPT patients. Objectives We aimed to compare demographic, clinical and biochemical parameters of PHPT patients with and without renal manifestations and also analysed the influence of curative parathyroidectomy on renal functions. Methods We retrospectively analysed the data of PHPT patients from the last 25 years (1995‐ March 2019) and compared the demographic and clinical presentation and biochemical measurements between patients with and without renal manifestations and evaluated the changes in renal functions after 1 year of curative parathyroidectomy. Results Of the total 544 PHPT patients, 299 (55%) including 91 out of 141 (65%) males had renal manifestations. Among renal manifestations, nephrolithiasis and nephrocalcinosis were found in 41.7% and 27.6% PHPT patients, respectively. PHPT patients with renal manifestations had significantly higher creatinine (109.7 vs 79.6 µmol/L; P < .0001) and lower eGFR level (78.8 vs 93.9 mL/min/1.73 m2; P < .0001) compared to patients without renal manifestations. Parathyroidectomy resolved the clinical symptoms with biochemical cure in the patients from both the groups. Patients with renal manifestations showed improvement in creatinine and eGFR levels after 1 year of curative parathyroidectomy; however, patients without renal manifestations showed no change in creatinine and eGFR levels. Conclusion Young age and male gender are predictors of renal manifestations in PHPT. Curative parathyroidectomy improves renal functions in PHPT patients with renal manifestations compared to PHPT patients without renal manifestation.

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Does renal function improve after parathyroidectomy in primary hyperparathyroidism?

Cited by 5 publications

References 36 publications

The Effect of Parathyroidectomy Compared to Non-Surgical Surveillance on Kidney Function in Primary Hyperparathyroidism: A Nationwide Historic Cohort Study

The Effect of Parathyroidectomy Compared to Non-Surgical Surveillance on Kidney Function in Primary Hyperparathyroidism: A Nationwide Historic Cohort Study

Effects of denosumab as compared with parathyroidectomy regarding calcium, renal, and bone involvement in osteoporotic patients with primary hyperparathyroidism

A detailed appraisal of renal manifestations in primary hyperparathyroidism from Indian PHPT registry: Before and after curative parathyroidectomy

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