Ann Surg Treat Res.  2020 Jan;98(1):1-6. 10.4174/astr.2020.98.1.1.

Predictors of early postoperative hypocalcemia after total parathyroidectomy in renal hyperparathyroidism

• Tan PG
• Ab. Hadi I
• Zahari Z
• Yahya MM
• Wan Zain W
• Wong MP
• Ramely R
• Md Hashim
• Syed Abd. Aziz SH
• Zakaria Z
• Zakaria AD

• KMID: 2466557
• DOI: http://doi.org/10.4174/astr.2020.98.1.1

Abstract

PURPOSE
Patients 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.
METHODS
Data 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.
RESULTS
Among 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).
CONCLUSION
Results 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.

Keyword

Hypocalcemia; Parathyroidectomy; Parathyroid hormone; Renal insufficiency; Secondary hyperparathyroidism

MeSH Terms

Alkaline Phosphatase
Calcium
Cohort Studies
Humans
Hyperparathyroidism*
Hyperparathyroidism, Secondary
Hypocalcemia*
Logistic Models
Muscle Weakness
Odds Ratio
Parathyroid Hormone
Parathyroidectomy*
Renal Insufficiency
Retrospective Studies
Alkaline Phosphatase
Calcium
Parathyroid Hormone

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