Does elective parathyroidectomy for primary hyperparathyroidism affect renal function? A prospective cohort study

• The effect of elective parathyroidectomy on kidney function has not been extensively studied.
• We examine associations between elective parathyroid surgery and post-operative renal impairment.
• A significant minority of patients undergoing parathyroid surgery demonstrate worsening renal function post-operatively.
• A pre-operative risk stratification tool may identify those at risk in the clinical setting.

IntroductionMajor surgery is associated with acute kidney injury (AKI). This study examines associations between elective parathyroid surgery and post-operative renal impairment.MethodsConsecutive patients undergoing elective parathyroidectomy were evaluated, and demographic data and relevant blood parameters collected. A renal risk score was calculated for each patient based on locally agreed criteria.Results62 patients were evaluated. Mean ± standard deviation creatinine increased between pre-operative and day 1 post-operative (72 ± 19 vs. 76 ± 20 μmol/L; p < 0.010). Mean eGFR reduced between baseline and day 1 (78 ± 15 vs. 75 ± 16; p < 0.010) and baseline and follow-up (78 ± 15 vs. 73 ± 17; p < 0.050). 19 patients (30.7%) had a creatinine increase of ≥10% on day 1 post-operatively and 7 (11.3%) a rise of >20%. At follow-up, 14 (30.4% of 46 patients with follow up creatinine measurements) and 5 (10.9%) patients had a creatinine of >10% and >20% higher than pre-operative or day 1 values respectively. Those with an increase in serum creatinine of ≥10% (at any time point) had a greater renal risk score [median 2 (inter-quartile range, IQR 0–3) vs. 1 (0–2); p = 0.040].ConclusionA significant minority of patients undergoing elective parathyroid surgery demonstrate worsening renal function post-operatively. A pre-operative risk stratification tool may identify those at risk in the clinical setting.