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Bone and Mineral Metabolism

Renal Outcomes Following Parathyroidectomy in Primary Hyperparathyroidism: A Comparative Systematic Review

Saturday, June 13, 2026
10:45 AM - 12:15 PM CT
Location: Room W176BC
Disclosure(s):
Mohammad Jay, Doctor of Medicine: No financial relationships to disclose
Aliya A. Khan, MD,FRCP,FACP, FACE: Ascendis Pharma: Grant Recipient ()


Background: Primary hyperparathyroidism (PHPT) increases the risk of renal stones and may contribute to chronic kidney disease (CKD). Although parathyroidectomy is recommended for renal involvement, its comparative effects on renal stone and function outcomes remain uncertain. We conducted a renal-focused systematic review comparing parathyroidectomy with non-surgical management in adults with PHPT.

Methods: We performed a PRISMA-guided systematic review (PROSPERO: CRD420251240480) of randomized controlled trials and comparative observational studies enrolling adults with biochemically confirmed PHPT. Screening and extraction were performed in duplicate. Primary outcomes were renal stone or renal function measures. Due to clinical and methodological heterogeneity, we performed a structured qualitative synthesis stratified by study design, baseline stone history, timing of surgery, and duration of follow-up, focusing on direction, magnitude, and consistency of effect estimates.

Results: Twenty-seven comparative studies were included (six randomized trials and twenty-one observational), comprising approximately 180,000 participants. Cohorts were predominantly female (70–80%) and included 5–10 years of follow-up. Renal stone definitions and ascertainment varied.
Across randomized trials, largely enrolling patients with mild or asymptomatic PHPT, effect estimates generally favored parathyroidectomy for reducing stone events; however, estimates were imprecise and frequently crossed the null, reflecting limited sample sizes and event rates. In contrast, large observational cohorts spanning a broader disease spectrum demonstrated heterogeneous results. Several population-based studies consistently reported higher stone rates in the early postoperative period, with attenuation over longer follow-up. Across study designs, renal stone outcomes varied systematically by baseline stone history, timing of surgery, and analytic approach, without consistent evidence of long-term stone risk reduction after surgery.
Renal function outcomes were reported less frequently but were more concordant. Across randomized trials and long-term observational studies, parathyroidectomy was not associated with sustained improvement in renal function or reduced CKD incidence, with any apparent benefit limited to selected subgroups, such as younger patients.

Conclusions: Parathyroidectomy does not uniformly improve renal outcomes in PHPT, and renal benefit appears highly contingent on baseline risk and timing of intervention. These findings challenge the use of renal manifestations as a standalone surgical indication and support a stratified approach prioritizing earlier intervention in patients most likely to benefit.

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