Patients with secondary hyperparathyroidism (SHPT) might live longer by undergoing parathyroidectomy, a new systematic review and meta-analysis suggests.
The surgery “remains even in the modern nephrology era a valid and viable therapeutic intervention especially for long-term dialysis patients,” according to Adrian Covic, MD, of Grigore T. Popa University in Romania, and colleagues.
The team conducted a meta-analysis of 15 studies published up to October 2016 and including 24,048 participants from 10 countries with chronic kidney disease stages 3-5. Results published in PLOS One showed a 26% lower risk for all-cause mortality in end-stage renal disease patients (ESRD) with SHPT who had surgery rather than pharmacologic treatment. Parathyroidectomy was also associated a 41% decreased risk of cardiovascular mortality in studies including nearly 10,000 patients. Adverse events were inconsistently reported.
The studies were mostly observational with a moderate risk for bias, limiting firm conclusions. They also did not yield sufficient information to compare total parathyroidectomy with or without autotransplantation and subtotal parathyroidectomy.
Dr Covic and his collaborators concluded that “the case for a properly conducted, independent randomised controlled trial comparing surgery with medical therapy and featuring many different outcomes from mortality to quality of life (QoL) is now very strong.”
Apetrii M, Goldsmith D, Nistor I, Siriopol D, Voroneanu L, Scripcariu D, et al. Impact of surgical parathyroidectomy on chronic kidney disease-mineral and bone disorder (CKD-MBD): A systematic review and meta-analysis. PLoS ONE. 12(11): e0187025. doi: 10.1371/journal.pone.0187025