Estimated Effect of Parathyroidectomy on Long-Term Kidney Function in Adults With Primary Hyperparathyroidism

Seib, CD; Ganesan, C; Furst, A; Pao, AC; Chertow, GM; Leppert, JT; Suh, I; Montez-Rath, ME; Harris, AHS; Trickey, AW; Kebebew, E; Kurella Tamura, M

doi:10.7326/m22-2222

Osteoporosis, bone & mineral

Estimated Effect of Parathyroidectomy on Long-Term Kidney Function in Adults With Primary Hyperparathyroidism

Ann Intern MedPublished 11 Apr 2023Target trial emulation using observational data

Main finding · Sustained eGFR decline ≥50%ResultHazard ratio 0.98 95% CI 0.82–1.16

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Authors' conclusion

Parathyroidectomy had no effect on long-term kidney function in older adults with PHPT. Potential benefits related to kidney function should not be the primary consideration for PHPT treatment decisions.

Study context

Population: Adults with a new biochemical diagnosis of PHPT in 2000 to 2019, Veterans Health Administration; mean age 66.8 years
Participants: 43,697 adults

Exposure: Parathyroidectomy vs nonoperative management
Outcome: Sustained eGFR decline ≥50%
Follow-up: Median 4.9 years

Methodological detailsextended Cox model with time-varying inverse probability weighting, Predominantly male cohort; observational data

Extended Cox model with time-varying inverse probability weighting
Predominantly male cohort; observational data

Main finding

As reported in the abstract

Hazard ratio

0.98

95% CI 0.82–1.16

Parathyroidectomyvs Nonoperative management

HR 0.98 (95% CI 0.82–1.16)

Patients with estimated glomerular filtration rate (eGFR) decline ≥50%, overall: 2928 (6.7%)

Observational data: associations, not effects.

Further findings

Weighted cumulative incidence of eGFR decline · 5 years

Parathyroidectomy5.1%

Nonoperative management5.1%

Weighted cumulative incidence of eGFR decline · 10 years

Parathyroidectomy10.8%

Nonoperative management12.0%

Outcome	← Lower risk with parathyroidectomy ←→ Higher risk with parathyroidectomy →	HR (CI)
Primary outcome, age <60 years	0.512	0.75 (0.59–0.93)
Primary outcome, age ≥60 years	0.512	1.08 (0.87–1.34)
	0.512Hazard ratio (log scale)

Subgroups by pretreatment kidney function

No heterogeneity of treatment effect based on pretreatment kidney function

Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.

Original publication

Estimated Effect of Parathyroidectomy on Long-Term Kidney Function in Adults With Primary Hyperparathyroidism. Ann Intern Med. Published 11 April 2023. doi:10.7326/m22-2222

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