Long-term effects of primary hyperparathyroidism and parathyroidectomy on kidney function

Importance Limited evidence supports kidney dysfunction as an indication for parathyroidectomy in asymptomatic primary hyperparathyroidism (PHPT). Objective To investigate the natural history of kidney function in PHPT and whether parathyroidectomy alters renal outcomes. Design Matched control study. Setting A vertically integrated health care system serving 4.6 million patients in Southern California. Participants 6058 subjects with PHPT and 16 388 matched controls, studied from 2000 to 2016. Exposures Biochemically confirmed PHPT with varying serum calcium levels. Main outcomes Estimated glomerular filtration rate (eGFR) trajectories were compared over 10 years, with cases subdivided by severity of hypercalcemia: serum calcium 2.62-2.74 mmol/L (10.5-11 mg/dL), 2.75-2.87 (11.1-11.5), 2.88-2.99 (11.6-12), and >2.99 (>12). Interrupted time series analysis was conducted among propensity-score-matched PHPT patients with and without parathyroidectomy to compare eGFR trajectories postoperatively. Results Modest rates of eGFR decline were observed in PHPT patients with serum calcium 2.62-2.74 mmol/L (-1.0 mL/min/1.73 m(2)/year) and 2.75-2.87 mmol/L (-1.1 mL/min/1.73 m(2)/year), comprising 56% and 28% of cases, respectively. Compared with the control rate of -1.0 mL/min/1.73 m(2)/year, accelerated rates of eGFR decline were observed in patients with serum calcium 2.88-2.99 mmol/L (-1.5 mL/min/1.73 m(2)/year, P2.99 mmol/L (-2.1 mL/min/1.73 m(2)/year, P2.87 mmol/L exhibited mitigation of eGFR decline after parathyroidectomy (-2.0 [95% CI: -2.6, -1.5] to -0.9 [95% CI: -1.5, 0.4] mL/min/1.73 m(2)/year). Conclusions and relevance Compared with matched controls, accelerated eGFR decline was observed in the minority of PHPT patients with serum calcium >2.87 mmol/L (11.5 mg/dL). Parathyroidectomy was associated with mitigation of eGFR decline in patients with serum calcium >2.87 mmol/L.

Automated summary

This study investigated the natural progression of kidney function in patients with primary hyperparathyroidism (PHPT) and whether parathyroidectomy has an effect on renal outcomes. The results showed that PHPT patients had an accelerated decline in kidney function compared to matched controls, and among patients with hypercalcemia, parathyroidectomy was associated with decreased decline in kidney function.