WEDNESDAY, April 12, 2023 (HealthDay News) — For adults with primary hyperparathyroidism (PHPT), parathyroidectomy has no effect on long-term kidney function versus nonoperative management, according to a study published online April 11 in the Annals of Internal Medicine.

Carolyn D. Seib, M.D., from the Stanford University School of Medicine in California, and colleagues compared the incidence of a sustained decline in estimated glomerular filtration rate (eGFR) of at least 50 percent among patients from the Veterans Health Administration with PHPT treated with parathyroidectomy versus nonoperative management.

The researchers found that during a median follow-up of 4.9 years, 6.7 percent of the 43,697 patients with PHPT had a decline of at least 50 percent in eGFR. At five and 10 years, the weighted cumulative incidence of eGFR decline was 5.1 and 10.8 percent, respectively, in patients managed with parathyroidectomy compared with 5.1 and 12.0 percent, respectively, among those managed nonoperatively. There was no difference seen in the adjusted hazard of eGFR decline between the parathyroidectomy and nonoperative management groups. Based on pretreatment kidney function, there was no heterogeneity of treatment effect noted in subgroup analyses. Among patients younger than 60 years, but not among those aged 60 years or older, parathyroidectomy was associated with a reduced hazard of the primary outcome.

“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 authors write.

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