Objective: Secondary hyperparathyroidism (SHPT) is a complication of chronic kidney disease (CKD), requiring parathyroidectomy in refractory cases. This study evaluated subtotal and total parathyroidectomy outcomes in CKD patients and identified preoperative factors associated with surgical success.
Materials and Methods: Adult CKD patients who underwent parathyroidectomy for secondary hyperparathyroidism at Gazi University Faculty of Medicine were included in this retrospective study. Incomplete surgical resolution of SHPT was defined as persistent (failure to achieve a 50% reduction in parathyroid hormone (PTH) levels at the first postoperative hour, per the Miami criterion) or recurrent (PTH levels exceeding the target range six months postoperatively [2- to 9-fold the upper limit of normal, per KDIGO (Kidney Disease: Improving Global Outcomes) guidelines]) hyperparathyroidism.
Results: Incomplete surgical resolution of SHPT occurred in 23% of patients, with higher rates in hemodialysis (HD) patients (36%) than in peritoneal dialysis (PD) patients (20%, p=0.245). Preoperative alkaline phosphatase (ALP) was the only significant predictor of surgical success (B=-0.003, p=0.011). Hungry bone syndrome (HBS) was observed in 73.3% of PD patients and 52% of HD patients (p=0.143). Total parathyroidectomy showed a trend toward fewer failures than subtotal parathyroidectomy.
Conclusion: Preoperative ALP is a critical predictor of parathyroidectomy success in SHPT. Total parathyroidectomy may offer improved outcomes compared to subtotal parathyroidectomy. Individualized surgical planning is essential for CKD patients with SHPT.