Quality of Life After Parathyroidectomy in Patients With End-Stage Renal Disease: A Systematic Review

Secondary hyperparathyroidism (SHPT) is a common complication of end-stage renal disease (ESRD), with parathyroid hormone (PTH) overproduction leading to symptoms such as bone pain, pruritus, and fatigue. These symptoms diminish the already compromised quality of life (QoL) in ESRD patients. Parathyroidectomy (PTX) is offered to those who fail medical management, but its association with QoL is not addressed in treatment guidelines. This systematic review examines QoL in SHPT patients after PTX.

A systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Databases were searched from 2014 to 2024 using terms including ESRD, chronic kidney disease, QoL, PTX, and SHPT. Two reviewers screened titles, abstracts, and full texts. The primary outcome was change in QoL as assessed by validated questionnaires.

Of 6234 articles reviewed, 10 (0.16%) studies met the inclusion criteria. There were 6 case series, 2 prospective cohort studies, 1 case control study, and 1 retrospective cohort study. Across these, 575 patients underwent PTX for symptomatic SHPT. QoL was assessed using Short-Form Health Survey (5 studies), Kidney disease quality of Life Instrument (4), parathyroidectomy assessment of symptoms(2), visual analog scale(2), and median symptom index score(1). All studies reported higher physical QoL scores after PTX compared to baseline. Improvement in mental health symptoms was variable.

PTX in patients with SHPT is associated with improved physical functioning and fewer mental health-related symptoms, with higher overall QoL. QoL and symptom burden may represent important factors in the decision to pursue surgical management for SHPT when medical management is not adequate.