Acute and long-term kidney function after parathyroidectomy for primary hyperparathyroidism

Abstract

Background In kidney transplant patients, parathyroidectomy is associated with an acute decrease in renal function. Acute and chronic effects of parathyroidectomy on renal function have not been extensively studied in primary hyperparathyroidism (PHPT). Methods This retrospective cohort study included 494 patients undergoing parathyroidectomy for PHPT. Acute renal changes were evaluated daily until day 4 post-parathyroidectomy and were stratified according to acute kidney injury (AKI) criteria. Biochemical assessment included serum creatinine, total and ionized calcium, parathyroid hormone (PTH), and 25-hydroxyvitamin D (25OHD). The estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI equation. We compared preoperative and postoperative renal function up to 5 years of follow-up. Results A total of 391 (79.1%) patients were female, and 422 (85.4%) were non-African American. The median age was 58 years old. The median (first and third quartiles) preoperative serum creatinine, PTH and total calcium levels were 0.81 mg/dL (0.68–1.01), 154.5 pg/mL (106–238.5), and 10.9 mg/dL (10.3–11.5), respectively. The median (first and third quartiles) preoperative eGFR was 86 mL/min/1.73 m2 (65–101.3). After surgery, the median acute decrease in the eGFR was 21 mL/min/1.73 m2 (p<0.0001). Acutely, 41.1% of patients developed stage 1 AKI, 5.9% developed stage 2 AKI, and 1.8% developed stage 3 AKI. The acute eGFR decrease (%) was correlated with age and PTH, calcium and preoperative creatinine levels in univariate analysis. Multivariate analysis showed that the acute change was related to age and preoperative values of ionized calcium, phosphorus and creatinine. The change at 12 months was related to sex, preoperative creatinine and 25OHD. Permanent reduction in the eGFR occurred in 60.7% of patients after an acute episode. Conclusion There was significant acute impairment in renal function after parathyroidectomy for PHPT, and almost half of the patients met the criteria for AKI. Significant eGFR recovery was observed during the first month after surgery, but a small permanent reduction may occur. Patients treated for PHPT seemed to present with prominent renal dysfunction compared to patients who underwent thyroidectomy.

The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Secondary and Tertiary Renal Hyperparathyroidism

“…AKI has been examined in patients undergoing PTX with several studies suggesting that makers of kidney function (eg, GFR and creatinine levels) acutely worsen in the immediate postoperative period. 121,[167][168][169][170] Although both serum creatinine and eGFR are strong predictors of postoperative AKI, risk prediction models that use eGFR demonstrate superior predictive power, thus it is recommended that baseline kidney function using eGFR be assessed within 1 month of surgery, and prediction tools such as the General Surgery AKI Risk Index can be utilized to determine the risk of AKI perioperatively. [171][172][173] Recommendation 5-1: Patients with CKD who are not dialysis dependent undergoing PTX should have baseline eGFR assessed at least 1 month before surgery to determine risk for perioperative acute kidney injury.…”

Association of Fibroblast Growth Factor 23 and Calcium in Chronic Kidney Disease Patients

“…Our study resembles with previous Pakistan study submitted representative by [9] which showed that from 265 patients enrolled for final analysis in this data with a male to female ratio of 1:1.03 (146/121), and another study in India by [10] Showed that the patients' mean age was 42.57 years but this result was lower than our result 55.07±10.5 year. but [11] Showed that (79%) were females and the median age was 58 years old. In addition, [12] from Spain showed that more cases were in females (39.1%) than males (29.6%) with age group (49-67) years.…”

A Case Report: Recurrent Hyperparathyroidism After Parathyroidectomy in a Primary Hyperparathyroidism Patient with Chronic Kidney Disease

“…In PHPT patients with a coexisting renal impairment, the results of renal function after PTX are still controversial. Although some retrospective studies show benefits to kidney function of patients undergoing PTX [4,10,17], other studies reported that PTX is associated with acute and permanent renal impairment in PHPT patients [18][19][20]. A prospective study of 494 patients undergoing PTX for PHPT reported a robust eGFR decrease of 21 mL/min/1.73 m 2 in the acute period, and 48.8% of patients fulfilled the KDIGO criteria for AKI [19].…”