# Outcomes of renal hyperparathyroidism following parathyroidectomy in kidney replacement therapy patients at a tertiary centre in South Africa: A retrospective cohort study

## TL;DR

This study examines the outcomes of parathyroidectomy in kidney failure patients in South Africa, finding high rates of postoperative complications and recurrence.

## Contribution

The study provides new insights into parathyroidectomy outcomes in a South African context with limited medical options.

## Key findings

- Hungry bone syndrome occurred in 98% of patients post-surgery.
- Recurrence of renal hyperparathyroidism was observed in 15% of patients.
- Total parathyroidectomy showed lower recurrence rates compared to subtotal.

## Abstract

Renal hyperparathyroidism is a frequent complication among patients with kidney failure. Data on outcomes following parathyroidectomy in patients undergoing kidney replacement therapy (KRT) remain limited in South Africa (SA). This study aimed to assess postoperative surgical and biochemical complication rates and disease recurrence.

We conducted a retrospective cohort study of adult KRT patients who underwent parathyroidectomy for renal hyperparathyroidism at Tygerberg Hospital over 7 years. Kaplan-Meier and univariate logistic regression analyses were used to determine predictors of recurrence.

Forty-six patients underwent parathyroidectomy. Two-thirds were female with a mean age of 40.7 ± 8.50 years. Preoperative serum calcium and parathyroid hormone (PTH) concentrations were 2.41 ± 0.27 mmol/L and 176.7 (interquartile range [IQR] 124.4–245.1) pmol/L, respectively. Most patients (80%) underwent subtotal parathyroidectomy. The most common postoperative complication was hungry bone syndrome (HBS), which occurred in 98% of patients, and the postoperative total calcium concentration was 1.63 ± 0.28 mmol/L, observed on day 4 or later. Overall, recurrence of renal hyperparathyroidism occurred in 15% of patients. There were no predictors of recurrence on univariate logistic regression.

A lower recurrence rate was observed in total parathyroidectomy and a lower hypoparathyroidism rate in subtotal parathyroidectomy (SPTX). Hungry bone syndrome was found to be the most frequent postoperative complication, reflecting more advanced disease at the time of surgery.

In the future, the focus at Tygerberg Hospital should be on earlier surgical referral considering our limited medical options, and the decision-making regarding the surgical procedure should be discussed in a multidisciplinary team, with a focus on individualised priorities.