Quality of Life After Parathyroidectomy in Chronic Kidney Disease-Related Hyperparathyroidism: A Systematic Review and Meta-Analysis.

BACKGROUND

Secondary and tertiary hyperparathyroidism (SHPT and THPT) are frequent complications of chronic kidney disease and kidney transplantation, often impairing quality of life (QoL) through bone pain, fatigue, and pruritus. Parathyroidectomy is the definitive treatment for refractory cases, yet its impact on patient-reported QoL outcomes remains uncertain.

METHODS

We conducted a systematic review and meta-analysis in accordance with PRISMA guidelines (PROSPERO CRD42025108038). Nine studies (n = 675) with validated QoL assessments and ≥ 6 months of follow-up were included. QoL was measured using SF-36, KDQOL, and Pasieka's parathyroid assessment of symptoms (PAS). Standardized mean differences (SMDs) were calculated, with analyses of physical (PCS) and mental (MCS) component summary scores. Meta-regression evaluated preoperative parathyroid hormone (PTH), calcium, and phosphorus as predictors of QoL change.

RESULTS

Parathyroidectomy significantly improved global QoL (Hedges' g = 1.05; 95% CI: 0.42-1.69; p = 0.0011), PCS (SMD = 0.85; 95% CI: 0.32-1.37; p < 0.001), and MCS (SMD = 0.40; 95% CI: 0.11-0.69; p = 0.001). PAS scores also improved (SMD = -1.66; 95% CI: -2.72 to -0.60; p = 0.004). Preoperative PTH, calcium, and phosphorus were not associated with postoperative QoL gains (p = 0.71, 0.54, 0.47). Both subtotal and total parathyroidectomy provided comparable benefits (p = 0.76).

CONCLUSION

Parathyroidectomy leads to meaningful QoL improvements in CKD-related hyperparathyroidism, regardless of surgical technique. Baseline biochemical markers do not predict postoperative gains. Standardized, long-term studies of patient-reported outcomes are needed to guide surgical decision-making.