Renal hyperparathyroidism: comparative outcomes of parathyroidectomy in two regional centres over 14 years

Introduction Renal hyperparathyroidism is a common complication of chronic kidney disease, often requiring parathyroidectomy (PTX) when medical therapy fails. Following surgical intervention, recurrence and postoperative complications, in particular hypocalcaemia, are variable. This study compares post-PTX outcomes between two UK centres, focusing on recurrence rates, length of stay (LOS) and factors influencing postoperative intravenous (IV) calcium administration. Methods A retrospective cohort study was conducted across two centres from 2008–2022. Demographic, biochemical, and clinical factors were analysed, with primary outcomes being disease recurrence and postoperative IV calcium requirement. Results In total, 114 patients were included: 66 from centre A and 48 from centre B. Some 65.2% underwent total parathyroidectomy in centre A vs 60.4% in centre B. The remainder were subtotal parathyroidectomies. Total recurrence was higher in centre A (34.8%) than centre B (20.8%) and a longer LOS was seen in centre A (median 5.5 days vs 3 days, p = 0.007). IV calcium use was higher in centre B (35.4% vs 24.2%, p = 0.194), although not statistically significant. Predictors of recurrence were limited, with preloading with alfacalcidol being protective in a univariate model (hazard ratio [HR] 0.33, p = 0.005). Higher postoperative phosphate, parathyroid hormone and alkaline phosphate levels were significant predictors of postoperative IV calcium in multivariate analysis (p < 0.05). Conclusions Significant differences in recurrence and LOS suggest that preoperative disease burden and perioperative management strategies influence outcomes. The higher recurrence at centre A may be linked to disease severity, while the shorter LOS and higher IV calcium use at centre B may reflect different pre- and postoperative care approaches. These findings highlight the need for careful management and identification of factors which may impact outcomes.