{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T16:45:37Z","timestamp":1782492337808,"version":"3.54.5"},"reference-count":32,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T00:00:00Z","timestamp":1778544000000},"content-version":"unspecified","delay-in-days":11,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,4,28]]},"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>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 (\u226518 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. Studies without a comparator, those focused exclusively on secondary or normocalcaemic hyperparathyroidism and case reports or series will be excluded. Primary outcomes are renal stones and renal functional outcomes (eg, CKD progression, \u226530% decline in eGFR, dialysis initiation). Secondary outcomes include health-related quality of life and adverse events. Two reviewers will independently screen records, extract data and assess risk of bias (Cochrane Risk-of-Bias 2 and Risk Of Bias In Non-randomised Studies of Interventions). Random-effects models will be used where appropriate, and heterogeneity assessed using I\u00b2. Publication bias will be assessed using appropriate quantitative or qualitative methods based on the available evidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Ethics approval is not required as only published data will be used. Findings will be disseminated through peer-reviewed publication and conference presentations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration number<\/jats:title>\n                    <jats:p>CRD420251240480.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-115297","type":"journal-article","created":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T15:25:44Z","timestamp":1778599544000},"page":"e115297","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Effect of parathyroidectomy versus non-surgical management on renal outcomes in primary hyperparathyroidism: protocol for a systematic review and meta-analysis"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-7299-4342","authenticated-orcid":false,"given":"Mohammad","family":"Jay","sequence":"first","affiliation":[{"name":"Department of Medicine, Division of Endocrinology, University of Toronto, Toronto, Ontario, Canada"},{"name":"Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon E","family":"Straus","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Geriatric Medicine, University of Toronto, Toronto, Ontario, Canada"},{"name":"Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael\u2019s Hospital, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sumiya","family":"Lodhi","sequence":"additional","affiliation":[{"name":"Department of Medicine, Western University, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aliya","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Medicine, Divisions of Endocrinology and Geriatrics, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priya","family":"Bapat","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Endocrinology, University of Toronto, Toronto, Ontario, Canada"},{"name":"Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7412-7993","authenticated-orcid":false,"given":"Lorraine L","family":"Lipscombe","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Endocrinology, University of Toronto, Toronto, Ontario, Canada"},{"name":"Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada"},{"name":"Department of Medicine, Women\u2019s College Hospital, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antoine","family":"Eskander","sequence":"additional","affiliation":[{"name":"Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada"},{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,5,12]]},"reference":[{"key":"2026062608323730000_16.5.e115297.1","doi-asserted-by":"publisher","DOI":"10.1038\/nrendo.2017.104"},{"key":"2026062608323730000_16.5.e115297.2","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1016\/j.ando.2022.05.003","article-title":"Calcium homeostasis and hyperparathyroidism: Nephrologic and endocrinologic points of view","volume":"83","author":"Lemoine","year":"2022","journal-title":"Ann Endocrinol (Paris)"},{"key":"2026062608323730000_16.5.e115297.3","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1001\/jamasurg.2016.2310","article-title":"The American Association of Endocrine Surgeons Guidelines for Definitive Management of Primary Hyperparathyroidism","volume":"151","author":"Wilhelm","year":"2016","journal-title":"JAMA Surg"},{"key":"2026062608323730000_16.5.e115297.4","doi-asserted-by":"crossref","unstructured":"Jay M , Andrei S , Hoang P , et al . 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