Risk factors for renal stone development in adults with primary hyperparathyroidism: a protocol for a systematic review and meta-analysis.

Abstract

Primary hyperparathyroidism (PHPT) is characterised by overactive parathyroid glands and consequent calcium dysregulation. Renal stones (RS) are a recognised complication and are associated with substantial morbidity. However, RS risk factors in PHPT are not well established, and recent international guidelines identify 'renal stone risk' as a research priority. We aim to summarise and meta-analyse evidence on prespecified risk factors for RS in adults with PHPT. This Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols-aligned protocol describes a systematic review and meta-analysis. MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials will be searched from inception. Eligible designs include prospective and retrospective cohort, case-control and cross-sectional studies of adults (≥18 years) with PHPT; randomised trials, case reports, commentaries and conference abstracts will be excluded. Two reviewers will independently screen records, extract data and assess risk of bias using the Quality in Prognostic Studies tool. Prespecified risk factors are age, sex, urinary calcium, serum calcium, serum parathyroid hormone and serum 25-hydroxyvitamin D. We will pool adjusted ORs (primary) and unadjusted estimates (secondary) using random-effects models, assess heterogeneity with the <i>I²</i> statistic and rate certainty with Grading of Recommendations Assessment, Development and Evaluation. Publication bias will be explored when ≥10 studies are available. Literature searches will be updated prior to analyses to ensure currency. Ethics approval is not required as only published data will be used. Findings will be disseminated through a peer-reviewed publication and conference presentations. CRD42024608180.