Efficacy and safety of radiofrequency ablation for secondary hyperparathyroidism: a systematic review and meta-analysis.

Background: Secondary hyperparathyroidism (SHPT) is a common complication of chronic kidney disease (CKD) that affects approximately 90% of end-stage renal disease and poses a significant threat to long-term survival and quality of life in patients.

Objectives: To assess whether radiofrequency ablation (RFA) is a productive and low-risk treatment for hyperparathyroidism secondary to CKD.

Methods: Embase, Web of Science, Cochrane Library, and PubMed were searched independently by two authors. The results after RFA and baseline biochemical indicators were compared, and parathyroid hormone (PTH), serum calcium, and serum phosphorus levels were the major outcomes.

Results: Four retrospective studies were screened out from 147 original literature and involved 118 cases. After RFA, serum PTH levels (1 d standardized mean difference [SMD] = -2.30, 95% confidence interval [CI] = from -3.04 to -1.56, P < 0.0001; 6 months SMD = -2.15, 95% CI = from -3.04 to -1.26, P < 0.0001; 12 months SMD = -2.35, 95% CI = from -3.52 to -1.17, P < 0.0001), serum calcium levels (1 d SMD = -1.49, 95% CI = from -2.18 to -0.81, P = 0.0001; 6 months SMD = -1.09, 95% CI = from -1.51 to -0.68, P < 0.0001), and serum phosphorus levels (1 d SMD = -1.37, 95% CI = from -1.67 to -1.07, P < 0.0001; 6 months SMD = -1.06, 95% CI = from -1.35 to -0.78, P < 0.0001) decreased significantly.

Conclusions: RFA, the newest thermal ablation technique, can effectively and safely treat hyperparathyroidism secondary to CKD. Hoarseness is the most common complication but is reversed within 6 months.