Parathyroidectomy may not arrest Kidney Function decline in elderly with primary hyperparathyroidism

USA: New research has revealed that parathyroidectomy, a surgical procedure to remove one or more parathyroid glands, has no effect on long-term kidney function in older adults with primary hyperparathyroidism (PHPT) according to a study published in the Annals of Internal Medicine.

The findings of the study challenge the multidisciplinary guidelines that recommend parathyroidectomy to slow the progression of chronic kidney disease in patients with PHPT and an estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73 m².

The study examined the incidence of a prolonged fall in eGFR of at least 50% among individuals treated with parathyroidectomy with nonoperative treatment using observational data recorded by the Veterans Health Administration with PHPT. Over a median follow-up of 4.9 years, 43,697 patients with PHPT were studied, with a mean age of 66.8 years.

The study concluded with the following clinical finding:

1. 1.6.7% of patients experienced a decline of at least 50% in eGFR over a median follow-up of 4.9 years.
2. 2.The weighted cumulative incidence of eGFR decline was 5.1% at 5 years and 10.8% at 10 years for patients managed with parathyroidectomy.
3. 3.The weighted cumulative incidence of eGFR decline was 5.1% at 5 years and 12.0% at 10 years for patients managed nonoperatively.
4. 4.The adjusted hazard of eGFR decline did not differ significantly between parathyroidectomy and nonoperative management.
5. 5.Parathyroidectomy was associated with a reduced hazard of the primary outcome among patients younger than 60 years, but not among those aged 60 years or older.

The study's authors added that “The analyses were done in a predominantly male cohort using observational data, which may limit the generalizability of the findings. Nevertheless, the study's large sample size and long follow-up period provide valuable insights into the long-term effects of parathyroidectomy on kidney function in patients with PHPT.”

The study's findings have important implications for clinicians and patients making treatment decisions for PHPT. While parathyroidectomy may be beneficial for some patients, particularly those younger than 60 years, potential benefits related to kidney function should not be the sole consideration.

Reference:

Seib C., Ganesan C., Furst A., Pao A., Chertow G., Leppert J., Suh I., Montez-Rath M., Harris A., Trickey A., Kebebew E., Tamura M.; Estimated Effect of Parathyroidectomy on Long-Term Kidney Function in Adults With Primary Hyperparathyroidism; ACP: Annals of Internal Medicine; doi: https://doi.org/10.7326/M22-2222