Efficacy and safety of radiofrequency ablation for secondary hyperparathyroidism: A systematic review and single-arm meta-analysis.

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.