Mohamed Sherif Ali Ahmed, Ahmed Hamouda, Hassan Magdy, Mohamed Attia Elfadali, Mohamed Hamouda Elkasaby, Mohamed Ehab Eldesoky, Mahmoud M Elsayed, Mohamed Elhawary
{"title":"Efficacy and Safety of Radiofrequency Ablation for Secondary Hyperparathyroidism: A Systematic Review and Single-Arm Meta-Analysis.","authors":"Mohamed Sherif Ali Ahmed, Ahmed Hamouda, Hassan Magdy, Mohamed Attia Elfadali, Mohamed Hamouda Elkasaby, Mohamed Ehab Eldesoky, Mahmoud M Elsayed, Mohamed Elhawary","doi":"10.1016/j.ando.2026.102549","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Radiofrequency ablation (RFA) has emerged as a minimally invasive alternative to surgery for secondary hyperparathyroidism (SHPT), but efficacy and safety are still under evaluation. This meta-analysis assesses the effectiveness and complications of ultrasound-guided RFA in SHPT.</p><p><strong>Methods: </strong>We searched PubMed, Scopus, Web of Science, and the Cochrane Library from inception to February 10, 2025, for studies enrolling dialysis patients with SHPT treated by ultrasound-guided RFA. We included observational cohorts and case series (≥10 patients) with ≥6 month's follow-up, reporting changes in intact parathyroid hormone (iPTH), serum calcium or phosphorus; conference Abstracts, case reports, non-human studies, and non-English-language publications were excluded. Random-effects models were used to pool standardized mean differences (SMDs) and complication rates; heterogeneity was assessed using I².</p><p><strong>Results: </strong>Eight retrospective studies (n = 349) were included. RFA was associated with significant reductions in iPTH at 1 day (SMD = -2.64, 95% CI -3.72 to -1.56; p < 0.00001), 6 months (SMD = -2.09, 95% CI -2.54 to -1.64; p < 0.00001), 12 months (SMD = -1.76, 95% CI -2.17 to -1.35; p < 0.00001), and at final follow-up (SMD = -1.47, 95% CI -1.85 to -1.09; p < 0.00001). Serum calcium decreased at 1 day (SMD = -1.26, 95% CI -2.22 to -0.30; p = 0.010), 6 months (SMD = -0.98, 95% CI -1.35 to -0.61; p < 0.00001), 12 months (SMD = -1.15, 95% CI -1.49 to -0.82; p < 0.00001), and final follow-up (SMD = -1.24, 95% CI -2.21 to -0.28; p = 0.010). Serum phosphorus also decreased at 1 day (SMD = -1.25, 95% CI -2.21 to -0.30; p = 0.010), 6 months (SMD = -0.77, 95% CI -1.03 to -0.51; p < 0.00001), 12 months (SMD = -0.73, 95% CI -0.95 to -0.50; p < 0.00001), and final follow-up (SMD = -0.75, 95% CI -1.01 to -0.49; p < 0.00001). Pooled complication rates included hypocalcemia (0.447, 95% CI 0.211-0.682), hoarseness (0.056, 95% CI 0.019-0.093), and recurrent laryngeal nerve injury/paralysis (0.027, 95% CI 0.000-0.066), with substantial heterogeneity in outcomes.</p><p><strong>Conclusion: </strong>RFA is an effective and safe alternative to parathyroidectomy for SHPT, with significant biochemical improvements and low risk of permanent complications. Long-term clinical trials are needed before drawing solid conclusions.</p>","PeriodicalId":93871,"journal":{"name":"Annales d'endocrinologie","volume":" ","pages":"102549"},"PeriodicalIF":2.9000,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annales d'endocrinologie","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1016/j.ando.2026.102549","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Radiofrequency ablation (RFA) has emerged as a minimally invasive alternative to surgery for secondary hyperparathyroidism (SHPT), but efficacy and safety are still under evaluation. This meta-analysis assesses the effectiveness and complications of ultrasound-guided RFA in SHPT.
Methods: We searched PubMed, Scopus, Web of Science, and the Cochrane Library from inception to February 10, 2025, for studies enrolling dialysis patients with SHPT treated by ultrasound-guided RFA. We included observational cohorts and case series (≥10 patients) with ≥6 month's follow-up, reporting changes in intact parathyroid hormone (iPTH), serum calcium or phosphorus; conference Abstracts, case reports, non-human studies, and non-English-language publications were excluded. Random-effects models were used to pool standardized mean differences (SMDs) and complication rates; heterogeneity was assessed using I².
Results: Eight retrospective studies (n = 349) were included. RFA was associated with significant reductions in iPTH at 1 day (SMD = -2.64, 95% CI -3.72 to -1.56; p < 0.00001), 6 months (SMD = -2.09, 95% CI -2.54 to -1.64; p < 0.00001), 12 months (SMD = -1.76, 95% CI -2.17 to -1.35; p < 0.00001), and at final follow-up (SMD = -1.47, 95% CI -1.85 to -1.09; p < 0.00001). Serum calcium decreased at 1 day (SMD = -1.26, 95% CI -2.22 to -0.30; p = 0.010), 6 months (SMD = -0.98, 95% CI -1.35 to -0.61; p < 0.00001), 12 months (SMD = -1.15, 95% CI -1.49 to -0.82; p < 0.00001), and final follow-up (SMD = -1.24, 95% CI -2.21 to -0.28; p = 0.010). Serum phosphorus also decreased at 1 day (SMD = -1.25, 95% CI -2.21 to -0.30; p = 0.010), 6 months (SMD = -0.77, 95% CI -1.03 to -0.51; p < 0.00001), 12 months (SMD = -0.73, 95% CI -0.95 to -0.50; p < 0.00001), and final follow-up (SMD = -0.75, 95% CI -1.01 to -0.49; p < 0.00001). Pooled complication rates included hypocalcemia (0.447, 95% CI 0.211-0.682), hoarseness (0.056, 95% CI 0.019-0.093), and recurrent laryngeal nerve injury/paralysis (0.027, 95% CI 0.000-0.066), with substantial heterogeneity in outcomes.
Conclusion: RFA is an effective and safe alternative to parathyroidectomy for SHPT, with significant biochemical improvements and low risk of permanent complications. Long-term clinical trials are needed before drawing solid conclusions.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
