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

BackgroundPrimary hyperparathyroidism (PHPT) is characterized by overactive parathyroid glands. Renal stones (RS) are a common complication of PHPT and is associated with increased morbidity. However, the risk factors for RS in PHPT are not well-established and the latest international PHPT guideline highlights the need for further research into this area. ObjectiveWe aim to summarize and meta-analyze the existing evidence on prespecified risk factors associated with RS in adults with PHPT. Methods and AnalysisWe will search MEDLINE, EMBASE, and Cochrane Central from inception. Two independent reviewers will screen studies and include prospective/retrospective cohort, case-control, and cross-sectional designs in adults ([≥]18 years) with PHPT. Randomized trials, conference abstracts, case reports, and commentaries will be excluded. Two reviewers will independently extract data on population characteristics, risk factors, RS outcomes, and assess risk of bias using the Quality in Prognostic Studies tool. A random-effects model will be used to pool odds ratios. We will separately pool adjusted (primary analyses) and unadjusted odds ratios (secondary analyses) with their corresponding 95% confidence intervals. Certainty will be evaluated with the Grading of Recommendations Assessment, Development, and Evaluation framework. Heterogeneity will be assessed using the I{superscript 2} statistic and publication bias will be evaluated with funnel plots. DiscussionEarly identification of patients with PHPT at high risk for RS can facilitate the implementation of preventive strategies and reduce morbidity. Furthermore, recognizing these risk factors can assist clinicians in prioritizing treatment for those at higher risk, ultimately improving patient outcomes. Protocol registrationThe protocol was registered in PROSPERO on November 14, 2024 (registration ID: CRD42024608180). FundingNo source of financial funding was used.