Predictors of early postoperative hypocalcemia after total parathyroidectomy in renal hyperparathyroidism

Abstract

PurposePatients with secondary hyperparathyroidism are at high risk for developing postoperative hypocalcemia. However, there are limited data regarding predictors of postoperative hypocalcemia in renal failure patient with secondary hyperparathyroidism. This study aimed to determine the clinical presentations of renal hyperparathyroidism and the predictors of early postoperative hypocalcemia after total parathyroidectomy.MethodsData of patients with renal hyperparathyroidism who underwent total parathyroidectomy between January 2007 to December 2014 were reviewed retrospectively. Patients were divided into 2 cohort groups according to their serum calcium levels within 24 hours of parathyroidectomy: the hypocalcemia group (calcium levels of 2 mmol/L or less), and the normocalcemia group (calcium levels more than 2 mmol/L). With the use of multivariable logistic regression analyses, the predictors of early postoperative hypocalcemia after total parathyroidectomy in patients with renal hyperparathyroidism were investigated.ResultsAmong 68 patients, 56 patients (82.4%) were symptomatic preoperatively. Fifty patients (73.5%) presented with bone pain and 14 patients (20.6%) had muscle weakness. Early postoperative hypocalcemia occurred in 25 patients (36.8%). Preoperative alkaline phosphatase level was the predictor of early postoperative hypocalcemia (adjusted odds ratio, 1.004; 95% confidence interval, 1.001–1.006; P = 0.002).ConclusionResults from our study show that most of the patients with renal hyperparathyroidism were symptomatic preoperatively and the most common clinical presentations were bone pain and muscle weakness. The significant predictor of early postoperative hypocalcemia after total parathyroidectomy was the preoperative alkaline phosphatase levels.

Risk Factors for Severe Hypocalcemia in Patients with Secondary Hyperparathyroidism after Total Parathyroidectomy

“…is study established that the prevalence of postoperative SH among the study subjects was 25.9%, and the results are comparable to those of previous studies [20][21][22]. e pathogenesis of postoperative SH is multifactorial but the primary mechanism may involve the abrupt removal of iPTH stimulation after parathyroidectomy; hence, osteoclastic activity is reduced but continues to cause excess calcium and phosphate to pass into the bones [23].…”

Risk factors for hypocalcemia in dialysis patients with refractory secondary hyperparathyroidism after parathyroidectomy: a meta-analysis

“…In total, five studies mentioned the results of age [ 5 , 14 , 15 , 18 , 19 ]. The statistical heterogeneity was high (I 2 =82%, p = 0.0002), and a random-effects model was used to perform a meta-analysis was performed on the unadjusted data.…”

“…Complications often seen in this condition include refractory pruritus, bone pain, muscular weakness, progressive soft tissue calcification, kidney stones, constipation, peptic ulcer disease, spontaneous long bone fracture, psychosis, dementia, and even risk of death [ 2–4 ]. Control of SHPT in the early stages is achieved through medical therapies including calcium supplements, vitamin D supplements, phosphate-poor diets, phosphate-binders, and the calcimimetic agents [ 5–7 ]. Despite the emergence of new therapeutic agents, most guidelines still recommend PTX as the treatment of choice in SHPT patients’ refractory to medical therapy.…”

“…Hypocalcemia or even hungry bone syndrome (HBS) after PTX is a well-known and severe complication [ 5 , 8–10 ] reported to affect most patients with chronic kidney disease (CKD). Hypocalcemia may trigger weakness, headache, paresthesia, muscle cramps, laryngeal stridor, seizures, cardiac arrhythmias, and tetany.…”

“…In severe situations, hypocalcemia may even cause sudden death [ 11 ]. Thus, it is beneficial and clinically significant to identify the high-risk patient group susceptible to postoperative hypocalcemia for more vigilant postoperative monitoring [ 5 ].…”