S.M. Lawler1, K. HoSang1, T. Nace2, L. Kuo1 1Temple University, Surgery, Philadelpha, PA, USA 2Temple University, Library, Philadelpha, PA, USA
Introduction:
Secondary hyperparathyroidism (2HPT) occurs as a consequence of end stage renal disease (ESRD). Parathyroid hormone (PTH) overproduction and subsequent hypercalcemia can manifest as physiologic and somatic symptoms, such as bone pain, pruritis, fatigue, and mood swings. These complications can compromise the already decreased quality of life (QoL) of ESRD patients. Parathyroidectomy (PTX) is a recommended management for patients with significant comorbidities or who fail medical management. The impact of parathyroidectomy on QoL is not factored into treatment guidelines. This systematic review evaluates the available literature on the impact on quality of life (QoL) after parathyroidectomy in patients with 2HPT.
Methods:
Detailed search strategies were developed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. The search was limited from 2014-2024, and relevant terms included: end-stage renal disease, chronic kidney disease, quality of life, parathyroidectomy, secondary hyperparathyroidism. Case studies, other literature/systematic reviews, and unfinished clinical trials were excluded, as well as studies involving pregnant or pediatric patients, studies published in foreign languages, and studies related to primary or tertiary hyperparathyroidism. Studies were screened by title and abstract by two blinded, independent reviewers, and repeated for full text article screening and selection. Patient characteristics were noted. The primary outcome was change in QoL through validated questionnaires. The ROB-2 Cochrane and Critical Appraisal Skills Programme (CASP) tools assessed the quality of each study.
Results:
Of 2,971 articles reviewed, 8 (0.27%) studies met inclusion criteria. There were 5 prospective cohort studies, 2 retrospective cohort studies, and 1 randomized control trial. A total of 642 patients underwent PTX for symptomatic 2HPT. The patients studied included 306 males and 336 females, with ages ranging from an average of 46-55 years. Studies assessed outcomes using the Short Form-36 Health Survey (SF-36), the Kidney Disease Quality of Life Instrument (KDQOL), and the Parathyroidectomy Assessment Score (PAS), a hyperparathyroidism symptom assessment tool. Seven studies reported improvement in QoL after PTX for patients with ESRD at time points ranging from 3 months to 10 years post-operatively, while one study found initial improvement in QoL at 1 month but not at later time points. In studies that also reported physiologic symptoms as an outcome, there were notable improvements in symptoms, such as pruritis, bone pain, and arthralgias.
Conclusion:
This systematic review found significant improvement in quality of life after parathyroidectomy for patients with secondary hyperparathyroidism secondary to ESRD. Efforts should be made to educate providers and patients alike on the potential for symptom improvement with this operation.