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.
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