Acute kidney injury after parathyroidectomy for primary hyperparathyroidism: prevalence and risk factors

Aim. To assess the prevalence of acute renal injury (AKI) among patients who underwent surgery for primary hyperparathyroidism (PHPT), to analyze the possible risk factors for the development of postoperative AKI. Materials and methods. A retrospective cohort study included 290 patients who underwent successful selective parathyroidectomy (PTx) for PHPT. We did not include patients who underwent re-operative surgeries. AKI was defined according to KDIGO-2012 criteria. Results. 106 of 290 patients (36.6%) met AKI criteria after PTx. High preoperative PTH values were associated with AKI risk (median 17,75 pmol/L [Q1-Q3: 12; 24.2] in AKI group vs 13.8 pmol/L [Q1-Q3: 10,2; 19.6] in non-AKI group, p=0.0004). High ΔPTH before/after surgery was also associated with AKI risk (median 16.7 pmol/L [Q1-Q3: 10; 23] in AKI group vs 11.35 pmol/L [Q1-Q3: 7.4; 17] in non-AKI group, p<0.0001). In patients who developed AKI maximum size of the parathyroid adenoma was significantly greater: 20 mm [Q1-Q3: 10; 25] vs 15 mm [Q1-Q3: 10; 20] in non-AKI patients, p=0.0184. AKI risk was also associated with high preoperative serum calcium level: 2.83±0.29 mmol/L in AKI group vs 2.71±0.22 mmol/L in non-AKI group, p=0.0158. AKI risk was significantly higher in those with proteinuria: RR=1.9 [95%CI 1.19; 3.54], OR=3.67 [95%CI 1,5; 8.73], р=0.0061. Notable, neither preexisting chronic kidney disease (RR=1,37 [95%CI 0.93; 1.9], OR=1,7 [95%CI 0.9; 3.2], p=0.1073) nor baseline estimate glomerular filtration rate (84.45 ml/min/1.73 m2 [Q1-Q3: 65.5; 96.6] and 76.6 ml/min/1.73 m2 [Q1-Q3: 64.9; 90.6] for AKI and non-AKI patients respectively, р=0.118) were not associated with the risk of postoperative kidney function impairment. Patients of age 60 years and older had greater risk of AKI: RR=1.32 [95%CI 1.03; 1.72], OR=1.72 [95%CI 1.07; 2.83], p=0.0265. There was no association of AKI with perioperative use of contrast media in small doses (р=0.245), or intraoperative hypotension (p=0,79). Conclusions. We observed a high prevalence of AKI in patients after parathyroidectomy for primary HPT. Preoperative risk stratification may help early recognition and treatment of renal function impairment. For those at risk of AKI, careful monitoring of renal function is necessary during the postoperative period.

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

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