Risk Factors of Severe Hypocalcemia After US-Guided Percutaneous Microwave Ablation of the Parathyroid Gland in Patients with Secondary Hyperparathyroidism

Abstract

Our aim was to identify potential risk factors associated with severe hypocalcemia (SH) after microwave ablation (MWA) in patients with secondary hyperparathyroidism (SHPT). This retrospective cross‐sectional study enrolled 204 consecutive patients (with 387 parathyroid glands) who underwent MWA between July 2015 and May 2018. Clinical parameters, laboratory indices, and parathyroid gland characteristics were analyzed to assess risk factors associated with SH after MWA. SH was defined as serum calcium level lower than 1.875 mmol/L (7.5 mg/dL) after MWA. Two models (I and II) for pre‐MWA and post‐MWA prediction were established, respectively. In accordance with the KDIGO guidelines, the target value for intact parathyroid hormone (iPTH) less than 300 pg/mL within 7 days after MWA was considered as a successful procedure. The success rate of MWA was 71.6% (146/204). The incidence of hypocalcemia and SH after MWA was 35.8% and 22.06%, respectively. The pre‐MWA prediction models I and II showed that high pre‐MWA iPTH, a dramatic reduction in iPTH, low pre‐MWA serum calcium, multiple ablated gland, and lack of pruritus symptoms were risk factors for developing SH. The accuracy (82.23% versus 83.25% in models I and II, respectively), sensitivity (34.88% versus 44.19%), specificity (95.45% versus 94.59%), positive predictive value (PPV) (68.18% versus 70.37%), and negative predictive value (NPV) (84% versus 85.37%) of both models were promising. The logistic regression fitting of the nomograms showed high prediction efficiency (0.845 and 0.863). High pre‐MWA iPTH, dramatic reductions in iPTH, low pre‐MWA serum calcium, multiple gland ablation, and no pruritus symptoms were predictors of SH. © 2019 American Society for Bone and Mineral Research.

Hypocalcemia after ultrasound-guided microwave ablation and total parathyroidectomy for secondary hyperparathyroidism: a retrospective study

“…Hypocalcemia is the most common medical complication following PTX or thermal ablation. Our study showed that hypocalcemia usually occurred one week after MWA [15]. However, in patients undergoing TPTX, although the serum calcium level tended to fall immediately after the operation, there might be a delay up to 2 weeks before it reached its lowest level.…”

“…According to the previous studies, the incidence of postoperative hypocalcemia and SH in SHPT patients ranges from 70% to 90% and from 37% to 57%, respectively [12,13]. Hypocalcemia and SH were also common in 37.6% and 22.1% SHPT patients after MWA [14,15]. As the principles and strategies of these two surgical methods are completely different, the occurrence of postoperative hypocalcemia will have their own characteristics.…”

Long‐term outcomes of microwave ablation for secondary hyperparathyroidism in maintenance hemodialysis patients

“…[3][4][5][6][7][8] Microwave ablation, as a minimally invasive therapeutic approach causing parathyroid cells to lose their endocrine functionality, has been increasingly used to treat SHPT. [9][10][11][12][13] Our preliminary study also shows that microwave ablation could be an alternative for secondary hyperparathyroidism in patients with maintenance hemodialysis. The long-term superiority of microwave ablation, however, should be clarified further.…”

Recommend-Response and Complications Comparing Radiofrequency Ablation Versus Parathyroidectomy for Secondary Hyperparathyroidism in Dialysis Patients

“…We found that the postoperative low calcium level of patients was signi cantly correlated with the higher baseline bALP level. Previous analysis indicated that preoperative ALP level as a risk factor for hypocalcemia 5,18,19 . In our study, patients with baseline bALP concentration more than 115 U/L were prone to hypocalcemia, the sensitivity was 80.0%, and the speci city was 63.6%.…”

“…Therefore, maintaining normal postoperative blood calcium is very important. Few studies have shown that preoperative alkaline phosphatase(ALP) 18 and PTH 19 levels are independent risk factors for postoperative SH in SHPT patients 5,20 .…”