Multivariate analysis of the causes of acute renal injury after parathyroidectomy for primary hyperparathyroidism

Aim: to conduct multivariate analysis of the risk factors for the development of postoperative acute kidney injury (AKI) after surgery for primary hyperparathyroidism (PHPT). Materials and methods: we performed a retrospective cohort study of 290 patients who underwent successful selective parathyroidectomy (PTx) for PHPT for the first time. AKI was defined according to KDIGO 2012 criteria. Results: the incidence of AKI in our cohort was 36.6%. We have grouped the risk factors as follows. Among the comorbid conditions, significant risk factors were age (ОR 1.05 [95%CI 1.02; 1.08] per a year, р=0.002), BMI (ОR 1.07 [95%CI 1.02; 1.13] per each kg/m2, р=0.005), anemia (yes/no ОR 3.38 [95%CI 1.38; 8.2], р=0.008), but not diabetes (yes/no ОR 0.96 [95%CI 0.42; 2.2], р=0.959), hypertension (yes/no ОR 1.29 [95%CI 0.62; 2.69], р=0.492), chronic kidney disease (yes/no ОR 1.06 [95%CI 0.5; 2.23], р=0.88). Among the PHPT-associated conditions, significant factors were: a history of fractures (yes/no ОR 5.6 [95%CI 1.4; 22.4], р=0.0015), bone mineral density value (BMD) (ОR 1.9 [95%CI 1.19; 3.03] per each SD, р=0.007). Among the "renal" risk factors - proteinuria (yes/no ОR 4.31 [95%CI 1.64; 11.35], р=0.003), eGFR (ОR 1.02 [95%CI 1.0; 1.03] per each ml/min/1.73 m2, р=0.042), use of ACE inhibitors/ARBs (ОR 2.84 [95%CI 1.58; 5.12], р=0.001), use of diuretics (ОR 2.23 [95%CI 1.11; 4.44], р=0.023), but not calcium channel blockers (ОR 1.75 [95%CI 0.88; 3.48], р=0.11), significantly increased risk of AKI. Intraoperative hypotension, minimal mean arterial pressure and hypotension duration did not increase the risk of AKI (р=0.945, 0.883 and 0.865, respectively). Among the specific PHPT-associated risk factors, significant were preoperative PTH level (ОR 1.03 [95%CI 1.01; 1.05] per each pmol/l, р=0.002), ∆ PTH (ОR 1.03 [95%CI 1.01; 1.06] per each pmol/l, р=0.003), but not preoperative serum ionized calcium level (ОR 0.4 [95%CI 0.06; 2.56] per each mmol/l, р=0.337) as well as the severity of its decrease (ОR 0.35 [95%CI 0.04; 3.53] per each mmol/l, р=0.352). Conclusions: the high risk of AKI after PTx for PHPT should be taken into account, risk factors of this complication should be identified and considered when planning PTx, special attention should be paid to modifiable risk factors: BMI, anemia, use of ACE inhibitors/ARBs, preoperative PTH level.

острое почечное повреждение, первичный гиперпаратиреоз, паратиреоидэктомия, паратиреоидный гормон, кальций, acute kidney injury, primary hyperparathyroidism, parathyroidectomy, parathyroid hormone, calcium

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