Subtotal Parathyroidectomy for the Treatment of Persistent Hyperparathyroidism After Kidney Transplantation
This study aims to clarify whether surgical treatment of persistent hyperparathyroidism after kidney transplantation offers clinically meaningful benefits compared with a conservative treatment strategy. Kidney transplant recipients (\>6 mo after transplantation) with persistent hyperparathyroidism (elevated PTH and either hypercalcemia or hypophosphatemia) will be randomized in a 1:1 ratio to either subtotal parathyroidectomy or conservative management according to standard clinical practice. The study is conducted as an open-label, randomized controlled pilot trial with a 12-month follow-up period. Outcomes include bone density, physical function, quality of life and symptom burden.
• Age \> 18 years and legally competent and able to understand spoken and written Danish
• Kidney transplantation ≥6 months prior (no upper limit of time after transplantation)
• Stable kidney graft function, defined as estimated GFR ≥ 30 ml/min/1.73m3
• On minimum two separate biochemical measurements:
⁃ PTH \> upper normal limit of assay and
• serum ionized calcium ≥1.33 mmol/L or
• serum total calcium ≥2.60 mmol/L or
• serum phosphate ≤0.60 mmol/L despite sufficient dietary intake
⁃ with measurements obtained within
• 3 months in patients 6-12 months post-transplant
⁃ and not attributable to calcium supplementation or treatment with thiazide diuretics or lithium.