P BALI1, M TIONG1, N D TOUSSAINT1, I RUDERMAN1
1The Royal Melbourne Hospital, Parkville, Australia
Aim: To evaluate short, medium- and long-term outcomes of patients with chronic kidney disease (CKD) undergoing parathyroidectomy for secondary hyperparathyroidism (SHPT).
Background: Surgical parathyroidectomy is an important management for severe and refractory SHPT in patients with CKD. SHPT is associated with increased bone turnover, cardiovascular mortality and vascular calcification. Parathyroidectomy is associated with short-term morbidity and mortality but long-term survival benefit. There is limited Australian data on outcomes post-parathyroidectomy.
Methods: We conducted a retrospective study of patients with CKD who underwent a parathyroidectomy for SHPT between January 2010 and January 2020 at a large tertiary referral centre. Biochemical outcomes and medication changes were examined 12 months pre- and post-surgery. Clinical outcomes, including hospital readmission, cardiovascular events and mortality were also assessed following parathyroidectomy.
Results: A total of 142 patients underwent parathyroidectomy for SHPT during the 10-year period. Mean patient age was 50.8±14.7 years, 119 (83.8%) patients were on dialysis (99 on haemodialysis). Fourteen patients (9.9%) had a previous parathyroidectomy or required re-do surgery during the study period. Significant immediate post-operative complications were seen in 10 patients, requiring admission to ICU (n=8) or return to theatre (n=2). Within the first 6 months, 27 patients (19 %) required hospital readmission. Within 12 months post-parathyroidectomy, 105 (73.9%) and 111 (78.2%) patients experienced at least one episode of hypercalcaemia (corrected calcium >2.6mmol/L) or hypocalcaemia (corrected calcium < 2.1mmol/L) respectively. Over a 12-month period there were three deaths, and eight patients experienced major cardiovascular events.
Conclusion: Fluctuations in serum calcium leading to potentially serious adverse outcomes are common post-parathyroidectomy, with >70% of patients affected. This study highlights a need for medium- and long-term management guidelines to help minimise fluctuations post-surgery.
Parul is a final year advanced trainee in nephrology based at the Royal Melbourne Hospital.