Microwave ablation vs. parathyroidectomy for secondary hyperparathyroidism in maintenance hemodialysis patients

Abstract

Introduction: Secondary hyperparathyroidism (SHPT) is a serious and common problem in patients undergoing maintenance hemodialysis. Minimally invasive microwave ablation (MWA) has been used to treat SHPT and shows some advantages. However, its efficacy is still undefined. The primary purpose of this study was to determine the efficacy and safety of MWA compared to total parathyroidectomy plus forearm autotransplantation. Methods: The SHPT patients who were undergoing maintenance hemodialysis (follow‐up for 6 to 24 months after treatments) were divided into a MWA group (n = 33) and a parathyroidectomy group (n = 48). The efficacy (serum intact parathyroid hormone [iPTH], calcium, and phosphorus levels) and safety (hoarseness, hypocalcaemia, and persistently low iPTH) were compared between the two groups. Additionally, the study explored potential predictors of response to MWA by a logistic regression analysis. Findings: There were no significant differences in baseline characteristics between the two groups. The rates of achieving the recommended goal for iPTH were significantly higher in the MWA group than that in the parathyroidectomy group at all follow‐up times: 57.58% vs. 12.50% at one‐day (P < 0.001), 45.45% vs. 16.67% at 1‐week (P = 0.005), 57.58% vs. 16.67% at 2‐week (P < 0.001), 57.58% vs. 22.92% at 1‐month (P = 0.002), and 69.70% vs. 35.42% at 3‐month (P = 0.002), 76.47% vs. 28.57% at 6‐month (P = 0.005), 87.50% vs. 47.37% at 12‐month (P = 0.008), and 81.82% vs. 52.63% at 24‐month (P = 0.015), respectively. However, there were no significant differences for phosphorus or calcium at any of the follow‐up times (P > 0.05). The persistently low iPTH was more in the parathyroidectomy group (64.6%) than that in the MWA group (0%) (P < 0.001), but there was no significant difference in hoarseness or hypocalcaemia (P > 0.05). Baseline levels of iPTH (P = 0.021) and patient age (P = 0.011) were determined as predictors by univariate logistic regression analysis. Conclusion: The MWA could be an alternative to parathyroidectomy for SHPT but its eventual superiority has to be demonstrated by a proper study.

Efficacy and safety of microwave ablation treatment for secondary hyperparathyroidism: systematic review and meta-analysis

“…The studies covered a period !8 years, from 2009 to 2017. Two were retrospective cohort studies [26,27], and six were retrospective self-control studies [28][29][30][31][32][33]. The mean follow-up period ranged from six to 23 months, and the sample size ranged from 9-56 patients.…”

“…All studies included in the meta-analysis reported calcium measurements obtained before MWA. Five articles reported calcium levels as measured one day after MWA [27,28,[30][31][32].…”

“…Data about phosphorus measurements obtained before MWA were reported in all articles. Five articles reported phosphorus measurements obtained one day after MWA [27,28,[30][31][32]. The heterogeneity among studies was not significant (p ¼ 0.242, I 2 ¼ 26.9%), so the fixed-effects model was used for the analysis.…”

“…The phosphorus measurements obtained one day after MWA were significantly lower than those obtained before MWA (WMD: 0.289, 95% CI: 0.163-0.415, p < 0.01) (Figure 4(A)). Four articles reported phosphorus measurements obtained at one week [26,27,29,30] and one month [26,27,29,31], respectively, after MWA. The heterogeneity among studies was significant, so the random-effects model was used for the analysis (p < 0.01, I 2 ¼ 86.5%; p < 0.01, I 2 ¼ 85.3%).…”

Risk Factors of Severe Hypocalcemia After US-Guided Percutaneous Microwave Ablation of the Parathyroid Gland in Patients with Secondary Hyperparathyroidism

“…According to the previous studies, the incidence of postoperative SH in SHPT patients ranges from 37% to 57% and potential clinical parameters (eg, preoperative serum iPTH, calcium, and pruritus) associated with the occurrence of SH after PTX have been identified . Hypocalcemia was also common in 38.3% to 45.5% SHPT patients after MWA treatment . However, there has been no such study to systematically evaluate the risk factors associated with SH after MWA.…”