Effect of parathyroidectomy versus non-surgical management on renal outcomes in primary hyperparathyroidism: protocol for a systematic review and meta-analysis

Introduction Primary hyperparathyroidism (PHPT) increases the risk of renal stones and progressive renal dysfunction. Parathyroidectomy is recommended for patients with renal involvement, yet whether surgery improves renal outcomes compared with non-surgical management remains unclear.

Prior reviews have focused mainly on biochemical or skeletal outcomes, included few renal events and largely predate recent large cohort studies using contemporary methods to evaluate renal stones, chronic kidney disease (CKD) progression and long-term estimated glomerular filtration rate (eGFR) decline. A contemporary renal-focused synthesis is needed to clarify the true renal benefits of parathyroidectomy.

We aim to evaluate the effect of parathyroidectomy versus non-surgical management on renal stones and broader renal outcomes in adults with PHPT. Methods and analysis This Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P)-aligned protocol describes a systematic review and meta-analysis comparing parathyroidectomy with non-surgical management in adults (≥18 years) with PHPT.

MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials will be searched from inception to 5 November 2025. Eligible studies include randomised trials, non-randomised interventional studies and observational comparative designs.