Microwave ablation vs. parathyroidectomy for secondary hyperparathyroidism in maintenance hemodialysis patients

Introduction: Secondary hyperparathyroidism (SHPT) is a serious and common problem in patients undergoing maintenance hemodialysis. Minimally invasive microwave ablation (MWA) has been used to treat SHPT and shows some advantages. However, its efficacy is still undefined. The primary purpose of this study was to determine the efficacy and safety of MWA compared to total parathyroidectomy plus forearm autotransplantation. Methods: The SHPT patients who were undergoing maintenance hemodialysis (follow-up for 6 to 24months after treatments) were divided into a MWA group (n=33) and a parathyroidectomy group (n=48). The efficacy (serum intact parathyroid hormone [iPTH], calcium, and phosphorus levels) and safety (hoarseness, hypocalcaemia, and persistently low iPTH) were compared between the two groups. Additionally, the study explored potential predictors of response to MWA by a logistic regression analysis. Findings: There were no significant differences in baseline characteristics between the two groups. The rates of achieving the recommended goal for iPTH were significantly higher in the MWA group than that in the parathyroidectomy group at all follow-up times: 57.58% vs. 12.50% at one-day (P <0.001), 45.45% vs. 16.67% at 1-week (P=0.005), 57.58% vs. 16.67% at 2-week (P <0.001), 57.58% vs. 22.92% at 1-month (P=0.002), and 69.70% vs. 35.42% at 3-month (P=0.002), 76.47% vs. 28.57% at 6-month (P=0.005), 87.50% vs. 47.37% at 12-month (P=0.008), and 81.82% vs. 52.63% at 24-month (P=0.015), respectively. However, there were no significant differences for phosphorus or calcium at any of the follow-up times (P >0.05). The persistently low iPTH was more in the parathyroidectomy group (64.6%) than that in the MWA group (0%) (P <0.001), but there was no significant difference in hoarseness or hypocalcaemia (P >0.05). Baseline levels of iPTH (P=0.021) and patient age (P=0.011) were determined as predictors by univariate logistic regression analysis. Conclusion: The MWA could be an alternative to parathyroidectomy for SHPT but its eventual superiority has to be demonstrated by a proper study.