Parathyroidectomy for primary hyperparathyroidism didn't affect kidney function in older patients

While parathyroidectomy was not associated with risk of estimated glomerular filtration rate decline in patients ages 60 years and older with primary hyperparathyroidism, there was reduced risk in younger patients, a retrospective study found.

Parathyroidectomy had no effect on long-term kidney function in older adults with primary hyperparathyroidism (PHPT), so the primary consideration for their treatment should not be potential benefits related to kidney function, a study found.

Researchers looked at Veterans Health Administration data on adult patients who had a new biochemical diagnosis of PHPT from 2000 to 2019. They compared the incidence of the primary outcome, a 50% or greater sustained decline in estimated glomerular filtration rate (eGFR), with parathyroidectomy versus nonoperative management. Results were published April 11 by Annals of Internal Medicine.

Among 43,697 patients with PHPT (mean age, 66.8 years), 6.7% had a decline of at least 50% in eGFR over a median follow-up of 4.9 years. The weighted cumulative incidence of eGFR decline was 5.1% at 5 years and 10.8% at 10 years in patients who underwent parathyroidectomy, compared with 5.1% and 12.0%, respectively, in patients who did not. The adjusted risk of eGFR decline was not different between parathyroidectomy and nonoperative management (hazard ratio [HR], 0.98; 95% CI, 0.82 to 1.16). However, the effect differed by age, with parathyroidectomy being associated with reduced risk among patients younger than age 60 years (HR, 0.75; 95% CI, 0.59 to 0.93) but not among those ages 60 years or older (HR, 1.08; 95% CI, 0.87 to 1.34).

Researchers noted that because of a higher-than-expected study dropout rate (25% in the parathyroidectomy group and 31.3% in the observation group), the study was underpowered for both the primary and secondary outcomes, with wide CIs that ranged from a significant protective effect to a significant harmful effect. Also, the studied population was 88% male (patients with PHPT are predominantly female) and likely had higher rates of comorbidity than non-veteran populations.

“When participating in shared decision making for older adults with PHPT, clinicians should not consider parathyroidectomy for potential benefits of preservation of kidney function,” the study authors wrote. “For younger patients, clinicians should discuss the potential benefit of parathyroidectomy to reduce the risk for [chronic kidney disease] and associated complications in adults with PHPT.”

An ACP Internist article discussed how targeted testing for primary hyperparathyroidism, especially in those who present with kidney stones and bone density issues, can help patients with this disorder get appropriate care.