Calcimimetics or parathyroidectomy for kidney transplant recipients: is there still a question? a systematic review, meta-analysis and trial sequential analysis

source extracted confidence: high 2026-04-09
#humans #kidney-transplantation #parathyroidectomy #hyperparathyroidism-secondary #calcimimetic-agents

Calcimimetics or parathyroidectomy for kidney transplant recipients: is there still a question? a systematic review, meta-analysis and trial sequential analysis

Koimtzis et al., 2025 | Endocrine | Meta Analysis

Citation

Koimtzis Georgios, Stefanopoulos Leandros, ... Psarras Kyriakos. Calcimimetics or parathyroidectomy for kidney transplant recipients: is there still a question? a systematic review, meta-analysis and trial sequential analysis. Endocrine. 2025-Jun;88(3):671-681. doi:10.1007/s12020-025-04189-9

Abstract

PURPOSE: Secondary hyperparathyroidism is one of the most common complications of chronic kidney disease. The optimal treatment for chronic kidney disease nowadays is kidney transplant. Nonetheless, hyperparathyroidism does not always resolve after transplantation leading to tertiary hyperparathyroidism. The management of tertiary hyperparathyroidism can be either medical (calcimimetics) or surgical (parathyroidectomy). The aim of this study is to compare the medical and surgical treatment in terms of control of hyperparathyroidism and long-term implications on kidney graft function. METHODS: We carried out a systematic review and meta-analysis of relevant studies up to March 2024 on MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Scopus databases. We compared the parathyroid hormone, calcium, creatinine and estimated glomerular filtration rate between the groups of patients that were treated with parathyroidectomy and those that were treated with calcimimetcs. Subsequently, we performed a trial sequential analysis to corroborate our findings. RESULTS: Four studies were included in the final analysis with a total number of 247 patients. Parathyroidectomy resulted in a greater decrease in parathyroid hormone and calcium levels (WMD 149.37, CI 95% 126.81-171.93, p < 0.0001 and WMD 0.7, CI 95% 0.45-0.96, p < 0.0001 respectively) but there was no difference between the surgical and medical management groups in the creatinine and eGFR levels (CI 95%, -0.62-0.17, p = 0.27 and CI 95%, -8.06 - 20.54 p = 0.39). The trial sequential analysis corroborated these findings. CONCLUSION: Parathyroidectomy is more effective in controlling hyperparathyroidism in kidney transplant recipients, as it leads to a greater decrease in parathyroid hormone and calcium levels. However, there is no difference in the long-term function of the kidney graft, as the creatinine and estimated glomerular filtration values were similar in the surgical and medical management groups.

Key Findings

Four studies were included in the final analysis with a total number of 247 patients. Parathyroidectomy resulted in a greater decrease in parathyroid hormone and calcium levels (WMD 149.37, CI 95% 126.81-171.93, p < 0.0001 and WMD 0.7, CI 95% 0.45-0.96, p < 0.0001 respectively) but there was no difference between the surgical and medical management groups in the creatinine and eGFR levels (CI 95%, -0.62-0.17, p = 0.27 and CI 95%, -8.06 - 20.54 p = 0.39). The trial sequential analysis corroborate

Outcomes Measured

  • Requires manual extraction

Population

Field Value
Population See abstract
Sample Size 247
Age Range See abstract
Condition See abstract

MeSH Terms

  • Humans
  • Kidney Transplantation
  • Parathyroidectomy
  • Hyperparathyroidism, Secondary
  • Calcimimetic Agents
  • Parathyroid Hormone

Evidence Classification

  • Level: Meta Analysis
  • Publication Types: Journal Article, Systematic Review, Meta-Analysis
  • Vertical: calcium

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09