Challenges and controversies in the surgical management of uremic hyperparathyroidism: A systematic review

Background: Prevalence of uremic hyperparathyroidism (uHPT), secondary and tertiary, continues to rise. Historically, surgery was the only durable treatment for these conditions, but with the development of pharmacologic options, the treatment landscape has shifted predominantly towards medical management. Presently, there is a paucity of clear guidelines for surgical indications in the treatment of uHPT. In this review, we will discuss the risks and benefits associated with surgical management of uHPT and will evaluate recent evidence and controversies surrounding indications for parathyroidectomy (PTX) in uHPT. Data sources: A systematic review of the literature was performed, in accordance with PRISMA guidelines, resulting in the evaluation of 69 articles. Conclusions: Significant controversy still exists regarding indications and timing of surgical management of uHPT. Although the benefits of PTX in the uHPT patient population have been established, there is a significant need for well-designed randomized clinical trials to further clarify existing guidelines and optimize treatment approaches. (C) 2018 Published by Elsevier Inc.