Ultrasound-Guided Ablation a Suitable Alternative for Refractory SHPT

Radiofrequency ablation for refractory secondary hyperparathyroidism is associated with faster recovery and less severe hypocalcemia compared with parathyroidectomy plus autotransplantation, according to investigators.

Minimally invasive radiofrequency ablation (RFA) can treat refractory secondary hyperparathyroidism (SHPT) with relative safety and efficacy compared with surgery, according to investigators.

In a retrospective study, 80 patients on dialysis who had parathyroid hormone (PTH) levels exceeding 800 ng/mL underwent ultrasound-guided RFA or parathyroidectomy with autotransplantation (PTx + AT) from January 2018 to February 2021. Compared with baseline, PTH levels had significantly declined at day 1 (160.7 and 226.6 ng/mL), day 7 (184.6 and 122.3 ng/mL), and 6 months (272.1 and 488.2 ng/mL) in the RFA and PTx+AT groups, respectively. Serum calcium, serum phosphorus, and visual analog scale scores also significantly declined from baseline in both groups, according to findings published by Song-Song Wu, MD, of Fujian Provincial Hospital in China, and colleagues in Kidney International Reports. Significant between-group differences in these biochemical parameters largely diminished by 3 months.

Recurrent laryngeal nerve injury occurred in more patients in the RFA than PTx+AT group (26.7% vs 16.7%, respectively) but the difference was nonsignificant. However, RFA significantly decreased the risk of severe hypocalcemia (20% vs 46.7%) and led to a significantly shorter hospital stay (7.53 vs 12.13 days) compared with PTx+AT, the investigators reported.

At 6 months, SHPT recurrence rates were comparable between groups: 23.3% RFA vs 30% PTX+AT group.

“Taken together, RFA is associated with less injury, faster recovery, fewer complications, and a significantly lower risk of postoperative [severe hypocalcemia] compared with PTX + AT, while achieving similar clinical efficacy, improvement in clinical symptoms, and long-term recurrence rate,” the investigators concluded. Their preliminary results need to be confirmed in larger studies.

Reference

Zhang DL, Chen S, Gao MZ, et al. Ultrasound-guided radiofrequency ablation: a new attempt to the treatment of refractory hyperparathyroidism secondary to CKD. Kidney Int Rep. Published online December 6, 2021. doi:10.1016/j.ekir.2021.11.038