# Quality of Life After Parathyroidectomy in Chronic Kidney Disease–Related Hyperparathyroidism: A Systematic Review and Meta‐Analysis

## TL;DR

This study finds that parathyroidectomy improves quality of life for patients with chronic kidney disease-related hyperparathyroidism, regardless of surgical method used.

## Contribution

The study provides the first meta-analysis of quality of life outcomes after parathyroidectomy in CKD-related hyperparathyroidism.

## Key findings

- Parathyroidectomy significantly improves global quality of life, physical, and mental component scores.
- Baseline biochemical markers like PTH, calcium, and phosphorus do not predict postoperative quality of life gains.
- Both subtotal and total parathyroidectomy provide similar benefits in quality of life improvement.

## Abstract

Secondary and tertiary hyperparathyroidism (SHPT and THPT) are frequent complications of chronic kidney disease and kidney transplantation, often impairing quality of life (QoL) through bone pain, fatigue, and pruritus. Parathyroidectomy is the definitive treatment for refractory cases, yet its impact on patient‐reported QoL outcomes remains uncertain.

We conducted a systematic review and meta‐analysis in accordance with PRISMA guidelines (PROSPERO CRD42025108038). Nine studies (n = 675) with validated QoL assessments and ≥ 6 months of follow‐up were included. QoL was measured using SF‐36, KDQOL, and Pasieka’s parathyroid assessment of symptoms (PAS). Standardized mean differences (SMDs) were calculated, with analyses of physical (PCS) and mental (MCS) component summary scores. Meta‐regression evaluated preoperative parathyroid hormone (PTH), calcium, and phosphorus as predictors of QoL change.

Parathyroidectomy significantly improved global QoL (Hedges' g = 1.05; 95% CI: 0.42–1.69; p = 0.0011), PCS (SMD = 0.85; 95% CI: 0.32–1.37; p < 0.001), and MCS (SMD = 0.40; 95% CI: 0.11–0.69; p = 0.001). PAS scores also improved (SMD = −1.66; 95% CI: −2.72 to −0.60; p = 0.004). Preoperative PTH, calcium, and phosphorus were not associated with postoperative QoL gains (p = 0.71, 0.54, 0.47). Both subtotal and total parathyroidectomy provided comparable benefits (p = 0.76).

Parathyroidectomy leads to meaningful QoL improvements in CKD‐related hyperparathyroidism, regardless of surgical technique. Baseline biochemical markers do not predict postoperative gains. Standardized, long‐term studies of patient‐reported outcomes are needed to guide surgical decision‐making.

Parathyroidectomy leads to meaningful QoL improvements in CKD‐related hyperparathyroidism, regardless of surgical technique. Baseline biochemical markers do not predict postoperative gains. Standardized, long‐term studies of patient‐reported outcomes are needed to guide surgical decision‐making.