Analysis Of Postoperative Efficacy And Complications Of Radiofrequency Ablation For Hyperparathyroidism Secondary To Chronic Renal Disease

Object:To study the efficacy and complications of ultrasound-guided radiofrequency ablation(RFA)in chronic kidney disease(CKD)patients with secondary hyperparathyroidism(SHPT).To investigate the effect of RFA treatment on serum fibroblast growth factor 23(FGF23)and its relationship with calcium and phosphorus metabolism in patients with SHPT associated with CKD.Methods:1.Review the clinical data of SHPT patients who received ultrasound-guided RFA treatment in the Department of Fujian Provincial Hospital from July 2017 to January 2021,including general information,examination results,time interval,treatment times,intraoperative conditions,postoperative complications and outcomes.The studies included :(1)Compare the changes of calcium,phosphorus parathyroid hormone(PTH)before and after RFA treatment.(2)The time interval and frequency of patients receiving RFA treatment were counted,and the changes in the complication rate of patients receiving repeated RFA treatment were analyzed.(3)Patients were grouped according to whether they had complications,severe hypocalcemia,and recurrent laryngeal nerve injury the first time they received RFA.Contrast complications group and non-complications group,laryngeal recurrent nerve injury group and no laryngeal recurrent nerve injury group,severe hypocalcemia group and no severe hypocalcemia group of gender,age,age of dialysis,dialysis,albumin,blood creatinine,alkaline phosphatase(ALP),blood calcium,phosphorus,PTH,hemoglobin,ferritin,melting nodule number and nodule maximum size.The risk factors for complications at the first-time patients received RFA were analyzed with univariate analysis and binary logistic regression.2.The serum levels of FGF23,serum calcium and serum phosphorus,and PTH levels before and after surgery were monitored in SHPT patients who received ultrasound-guided RFA treatment in the Department of Nephrology of Fujian Provincial Hospital from April 2018 to August 2020.The changes of FGF23 before and after RFA and its relationship with calcium,phosphorus and PTH were compared.Results:1.A total of 103 CKD patients(58 men,45 women)with secondary hyperparathyroidism were included in the study and RFA treatment was performed182 times.The results included :(1)PTH,calcium and phosphorus of 103 patients decreased after RFA treatment compared with those before surgery,with statistical significance(p<0.05).(2)A total of 52 patients received two times of RFA treatment within one month,and there was no statistical significance in the incidence of total complications and severe hypocalcemia between the first and second RFA treatment(P > 0.05).The incidence of recurrent laryngeal nerve injury after the second treatment was significantly higher than that after the first treatment(P < 0.05).(3)The melting nodule number in the complication group was significantly more than that in the non-complication group(p<0.05).Compared with the group without severe hypocalcemia,the severe hypocalcemia group had younger age,more melting nodule number,higher blood phosphorus and ALP monitoring results,and the differences were statistically significant(p<0.05).Age,serum phosphorus,ALP,and melting nodule number were independent risk factors for severe hypocalcemia after initial treatment with RFA.2.Twenty-four patients with SHPT associated with chronic kidney disease were enrolled in this study.No significant difference of serum FGF23 concentration was found before,4 hours and 12 hours after treatment(P > 0.05).There was no significant correlation between FGF23,calcium,phosphorus and PTH concentrations at any time point during the study period(P > 0.05).Conclusion:1.(1)In patients with SHPT associated with chronic kidney disease,radiofrequency ablation significantly reduced calcium,phosphorus and serum PTH levels.Radiofrequency ablation is an effective treatment for hyperparathyroidism secondary to chronic kidney disease.(2)In patients with hyperparathyroidism secondary to chronic kidney disease who received two treatments in a short period,the incidence of recurrent laryngeal nerve injury after the second treatment was significantly higher than that after the first treatment.(3)The number of nodules ablated is a correlative factor for the total complications of patients with hyperparathyroidism secondary to chronic renal disease after initial radiofrequency ablation.Age,serum phosphorus,ALP and the number of nodules are independent risk factors for severe hypocalcemia after the operation.2.(1)Patients with hyperparathyroidism secondary to chronic kidney disease who underwent radiofrequency ablation had no significant effect on serum FGF23 levels in the short term.(2)No correlation between FGF23 and changes in calcium,phosphorus and PTH levels in patients with chronic renal disease secondary to hyperparathyroidism in the short term after radiofrequency ablation was observed.