Efficacy and safety of radiofrequency ablation for secondary hyperparathyroidism: A systematic review and single-arm
Mohamed Sherif Ali Ahmed1, Ahmed Hamouda2, Hassan Magdy3
1Mansoura University Hospitals, Mansoura University, Mansoura, Egypt.
Background:
Radiofrequency ablation (RFA) has emerged as a minimally invasive alternative to surgery for secondary hyperparathyroidism (SHPT), but efficacy and safety are still under evaluation. This meta-analysis assesses the effectiveness and complications of ultrasound-guided RFA in SHPT.
Methods:
We searched PubMed, Scopus, Web of Science, and the Cochrane Library from inception to February 10, 2025, for studies enrolling dialysis patients with SHPT treated by ultrasound-guided RFA. We included observational cohorts and case series (≥10 patients) with ≥6 month's follow-up, reporting changes in intact parathyroid hormone (iPTH), serum calcium or phosphorus; conference Abstracts, case reports, non-human studies, and non-English-language publications were excluded. Random-effects models were used to pool standardized mean differences (SMDs) and complication rates; heterogeneity was assessed using I2.
Results:
Eight retrospective studies (n=349) were included. RFA was associated with significant reductions in iPTH at 1 day (SMD=-2.64, 95% CI -3.72 to -1.56; P<0.00001), 6 months (SMD=-2.09, 95% CI -2.54 to -1.64; P<0.00001), 12 months (SMD=-1.76, 95% CI -2.17 to -1.35; P<0.00001), and at final follow-up (SMD=-1.47, 95% CI -1.85 to -1.09; P<0.00001). Serum calcium decreased at 1 day (SMD=-1.26, 95% CI -2.22 to -0.30; P=0.010), 6 months (SMD=-0.98, 95% CI -1.35 to -0.61; P<0.00001), 12 months (SMD=-1.15, 95% CI -1.49 to -0.82; P<0.00001), and final follow-up (SMD=-1.24, 95% CI -2.21 to -0.28; P=0.010). Serum phosphorus also decreased at 1 day (SMD=-1.25, 95% CI -2.21 to -0.30; P=0.010), 6 months (SMD=-0.77, 95% CI -1.03 to -0.51; P<0.00001), 12 months (SMD=-0.73, 95% CI -0.95 to -0.50; P<0.00001), and final follow-up (SMD=-0.75, 95% CI -1.01 to -0.49; P<0.00001). Pooled complication rates included hypocalcemia (0.447, 95% CI 0.211-0.682), hoarseness (0.056, 95% CI 0.019-0.093), and recurrent laryngeal nerve injury/paralysis (0.027, 95% CI 0.000-0.066), with substantial heterogeneity in outcomes.
Conclusion:
RFA is an effective and safe alternative to parathyroidectomy for SHPT, with significant biochemical improvements and low risk of permanent complications. Long-term clinical trials are needed before drawing solid conclusions.
