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Parathyroidectomy slows renal function decline in patients with primary hyperparathyroidism

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Abstract

Purpose

Primary hyperparathyroidism has deleterious effects on health and causes nephrolithiasis and osteoporosis. However, it remains unclear whether parathyroidectomy benefits kidney function among patients with primary hyperparathyroidism.

Methods

In this retrospective study, patients with primary hyperparathyroidism receiving parathyroidectomy in a tertiary medical center between 2003 and 2017 were followed up until December 31 2017, death, or requiring renal replacement therapy. Impact of parathyroidectomy on kidney function was examined using longitudinal estimated glomerular filtration rate (eGFR) change scales: single, average, absolute difference, percent change, annual decline rate, and slope. We applied linear mixed-effect model to determine the effect of parathyroidectomy on kidney function.

Results

During study period, 167 patients with primary hyperparathyroidism were identified from 498 parathyroidectomized patients, and finally, 27 patients fulfilled our stringent criteria. Median follow-up duration was 1.50 years (interquartile range 1.05–1.81) before surgery and 2.47 years (1.37–6.43) after surgery. Although parathyroidectomy did not affect amount of proteinuria and distribution of eGFR, parathyroidectomy significantly slowed decline rate of eGFR compared with that before surgery (− 1.67 versus − 2.73 mL/min/1.73 m2/year, p < 0.001). More importantly, parathyroidectomy made more beneficial effects on kidney function in patients with age < 65 years and those without chronic kidney disease or hypertension.

Conclusions

Our study showed that parathyroidectomy slows renal function decline irrespective of age or comorbidities, which offers novel insight into the revision of guidelines for surgical indications in primary hyperparathyroidism. Given small sample size, further large-scale controlled studies are warranted to confirm our findings.

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Data availability

The datasets generated during and/or analyzed during the current study are not publicly available, but are available from the corresponding author on reasonable request.

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Funding

This study was supported in part by China Medical University Hospital (DMR-109-028). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Author information

Authors and Affiliations

  1. Kidney Institute and Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan

    C.-C. Liang, H.-C. Yeh & C.-C. Kuo

  2. College of Medicine, China Medical University, Taichung, Taiwan

    C.-C. Liang, H.-C. Yeh, S.-P. Hsu & C.-C. Kuo

  3. Big Data Center, China Medical University Hospital and China Medical University, Taichung, Taiwan

    Y.-C. Lo, H.-C. Tsai & C.-C. Kuo

  4. Division of Nephrology, Asia University Hospital, Taichung, Taiwan

    C.-Y. Chou

  5. Department of Post-Baccalaureate Veterinary Medicine, Asia University, Taichung, Taiwan

    C.-Y. Chou

  6. Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan

    T.-H. Yen

  7. Division of Endocrinology and Metabolism, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan

    S.-P. Hsu

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  1. C.-C. Liang
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Contributions

CCL: study concept, design, and drafting of the manuscript. YCL and HCT: acquisition of data and analysis. HCY, CCK, and SPH: interpretation of data and revision of the manuscript. THY and CYC: critical revision of the manuscript for important intellectual content. CCK: study supervision.

Corresponding author

Correspondence to C.-C. Kuo.

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Conflict of interest

The results presented in part at the Annual Meeting of the Taiwan Society of Nephrology held 22–24 November 2019 in Taipei, Taiwan. The authors have no conflicts of interest regarding the design or publication of this study. This work will not be submitted for publication elsewhere until the editorial board has decided whether to publish the article.

Ethical approval

The study was approved by the Big Data Center of China Medical University Hospital and the Research Ethical Committee/Institutional Review Board of China Medical University Hospital (CMUH105-REC3-068).

Informed consent

The need to obtain informed consent for the present study was waived by the Research Ethical Committee of China Medical University Hospital.

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Liang, CC., Yeh, HC., Lo, YC. et al. Parathyroidectomy slows renal function decline in patients with primary hyperparathyroidism. J Endocrinol Invest 44, 755–763 (2021). https://doi.org/10.1007/s40618-020-01369-4

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  • DOI: https://doi.org/10.1007/s40618-020-01369-4

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