Patients with secondary hyperparathyroidism (SHPT) enjoy better quality of life after parathyroidectomy (PTx), according to a systematic review published in Nephrology Dialysis Transplantation.
“It is well established that the quality of life of patients with end-stage renal disease and hyperparathyroidism is severely compromised, not only by disease itself, but also due to the burden of treatment,” lead author Willemijn van der Plas, MD, told Renal & Urology News. “Our systematic review showed that surgery improves quality of life in these patients significantly, whereas cinacalcet does not convincingly show a positive effect.”
PTx for SHPT patients improved mean physical component scores by 35.5% and mental component scores by 13.7% on the Medical Outcomes Study Short Form, according to the team’s review of 5 observational, uncontrolled studies. Symptom scores dropped from 561 to 302. Patients reported less skin itching by 46.6%, joint pain by 30.4%, and muscle weakness by 28.7% on the visual analogue scale. Complications were uncommon and included surgical site problems (3.5%), temporary recurrent laryngeal nerve damage (1.8%), and intensive care admission (0.8%)
By comparison, no significant improvement in quality of life was observed with the calcimimetic cinacalet, according to 3 studies.
Quality of life is multifactorial so “it remains difficult to assess the true benefit of surgery alone in the absence of sham controls,” the authors wrote. They were unable to perform a meta-analysis and rule out publication bias. A direct comparison of PTx and cinacalcet is still warranted.
van der Plas WY, Dulfer RR, Engelsman AF, et al. Effect of parathyroidectomy and cinacalcet on quality of life in patients with end-stage renal disease-related hyperparathyroidism: a systematic review. Nephrol Dialy Trans. doi: 10.1093/ndt/gfx044