Ultrasound-Guided Radiofrequency Ablation: A New Attempt to the Treatment of Refractory Hyperparathyroidism Secondary to Chronic Kidney Disease

Dan-Ling Zhang; Sheng Chen; Mei-Zhu Gao; Yu-Cheng Lin; Fu-Yuan Hong; Zhen-Hui You; Xing Chen; Song-Song Wu

doi:10.1016/j.ekir.2021.11.038

Ultrasound-Guided Radiofrequency Ablation: A New Attempt to the Treatment of Refractory Hyperparathyroidism Secondary to Chronic Kidney Disease

Kidney Int Rep. 2021 Dec 7;7(2):282-288. doi: 10.1016/j.ekir.2021.11.038. eCollection 2022 Feb.

Authors

Dan-Ling Zhang¹, Sheng Chen², Mei-Zhu Gao³, Yu-Cheng Lin⁴, Fu-Yuan Hong³, Zhen-Hui You⁵, Xing Chen⁵, Song-Song Wu²

Affiliations

¹ Department of Ultrasonography, Shengli Clinical College of Fujian Medical University, Fuzhou No. 7 Hospital, Fuzhou, People's Republic of China.
² Department of Ultrasonography, Shengli Clinical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, People's Republic of China.
³ Department of Nephrology, Shengli Clinical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, People's Republic of China.
⁴ Department of Ultrasonography, Shengli Clinical College of Fujian Medical University, Affiliated Fuzhou First Hospital of Fujian Medical, Fuzhou, People's Republic of China.
⁵ Department of General Surgery, Shengli Clinical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, People's Republic of China.

Abstract

Introduction: To evaluate clinical application value of radiofrequency ablation (RFA) in refractory hyperparathyroidism secondary to chronic kidney disease (CKD) by comparing the safety and effectiveness of RFA with parathyroidectomy with autotransplantation (PTX + AT).

Methods: A retrospective study was conducted on 80 patients with CKD with refractory hyperparathyroidism who underwent RFA or PTX + AT between January 2018 and February 2021. Serum parathyroid hormone (PTH), calcium, and phosphorus levels, complications, clinical symptoms, visual analogue scale (VAS) scores, hospital stay duration, and postoperative recurrence rate were compared between the 2 groups.

Results: Serum PTH, phosphorous, and calcium levels and the VAS scores improved significantly after RFA and PTX + AT (P < 0.05). Significant differences were observed between the 2 groups in postoperative (day 1 and week 1) levels of serum PTH and postoperative day 1 of serum calcium and phosphorus levels (P < 0.05), with more pronounced reduction after PTX + AT. Although the incidence of recurrent laryngeal nerve (RLN) injury was slightly higher in the RFA group compared with the PTX + AT group (26.67% vs. 16.67%; P > 0.05), RFA markedly decreased the risk of severe hypocalcemia (SH) (20% vs. 46.67%; P < 0.05) and shortened hospital stay (7.53 ± 2.67 days vs. 12.13 ± 3.86 days; P < 0.05). The 6-month recurrence rate was 23.3% (7 of 30) in the RFA group and 30% (9 of 30) in the PTX + AT group (P > 0.05).

Conclusion: RFA can treat refractory secondary hyperparathyroidism (SHPT) with similar clinical efficacy as surgery and achieve faster recovery and a lower incidence of postoperative SH.

Keywords: chronic kidney disease (CKD); parathyroidectomy with autotransplantation (PTX + AT); radiofrequency ablation (RFA); secondary hyperparathyroidism (SHPT); severe hypocalcemia (SH).