Korean J Intern Med.  2015 Nov;30(6):856-864. 10.3904/kjim.2015.30.6.856.

Predicting postoperative total calcium requirements after parathyroidectomy in secondary hyperparathyroidism

• Kang BH
• Hwang SY
• Kim JY
• Hong YA
• Jung MY
• Lee EA
• Lee JE
• Lee JB
• Ko GJ
• Pyo HJ
• Kwon YJ

• KMID: 2381590
• DOI: http://doi.org/10.3904/kjim.2015.30.6.856

Abstract

BACKGROUND/AIMS
To prevent hypocalcemia after parathyroidectomy (PTX), parenteral calcium is required in addition to oral calcitriol and calcium. After switching to oral calcium, patients can be discharged from the hospital. The aim of this study was to analyze the clinical characteristics and outcomes of PTX performed at a single Korean center and to investigate the associated laboratory factors used to analyze the total amount of postoperative calcium required.
METHODS
We enrolled 91 hemodialysis patients undergoing PTX from November 2003 to December 2011. We collected clinical and laboratory data preoperatively, 12 and 48 hours postoperatively, at discharge, and 3 and 6 months postoperatively.
RESULTS
In total, 59 patients underwent PTX with autotransplantation (AT), 6 underwent total PTX without AT, 11 underwent subtotal PTX, and 15 underwent limited PTX. Total PTX without AT showed the lowest recurrence rate. At all postoperative time points, the mean levels of serum calcium, phosphorus, and intact parathyroid hormone (iPTH) decreased significantly, compared with preoperative levels; however, alkaline phosphatase (ALP) increased significantly from 48 hours postoperatively to discharge (p < 0.001). On multiple linear regression analysis, the total amount of injected calcium during hospitalization showed a significant correlation with preoperative ALP (p < 0.001), preoperative iPTH (p = 0.037), and Deltaphosphorus at 48 hours (p < 0.001). We developed an equation for estimating the total calcium requirement after PTX.
CONCLUSIONS
Preoperative ALP, preoperative iPTH, and Deltaphosphorus at 48 hours may be significant factors in estimating the postoperative calcium requirement. The formula for postoperative calcium requirement after PTX may help to predict the duration of postoperative hospitalization.

Keyword

Hyperparathyroidism; Secondary; Parathyroidectomy; Kidney failure, chronic

MeSH Terms

Administration, Intravenous
Administration, Oral
Adult
Aged
Biomarkers/blood
Calcium/blood
Calcium Carbonate/*administration & dosage
Calcium Compounds/*administration & dosage
Calcium Gluconate/*administration & dosage
*Decision Support Techniques
*Dietary Supplements
Female
Humans
Hyperparathyroidism, Secondary/blood/diagnosis/*surgery
Hypocalcemia/diagnosis/etiology/*prevention & control
Lactates/*administration & dosage
Linear Models
Male
Middle Aged
Models, Biological
Multivariate Analysis
Parathyroid Hormone/blood
Parathyroidectomy/*adverse effects
Phosphorus/blood
Recurrence
Republic of Korea
Retrospective Studies
Risk Factors
Time Factors
Treatment Outcome
Young Adult
Biomarkers
Calcium
Calcium Carbonate
Calcium Compounds
Calcium Gluconate
Lactates
Parathyroid Hormone
Phosphorus