Abstract
Background Hypocalcemia is the most common complication of total parathyroidectomy in secondary hyperparathyroidism (SHPT) and is associated with adverse consequences such as spasms, epilepsy, and arrhythmia and even death if the serum calcium level decreases rapidly. Previous studies have identified several risk factors for postoperative severe hypocalcemia (SH) in patients with SHPT, but the sample sizes were small and thus the results may not be reliable. Objectives This study was performed to investigate the risk factors for SH after total parathyroidectomy without autotransplantation (tPTX) in a large sample of patients with uremic hyperparathyroidism. Methods We retrospectively investigated the records of 1,095 patients with SHPT treated with tPTX between January 2008 and December 2018. Based on the postoperative serum calcium concentration, the patients were grouped into SH and non-SH groups. The clinical characteristics and biochemical results were analyzed, and binary logistic regression analysis was used to identify the risk factors for SH. Results After surgery, 25.9% of the patients developed SH. Age, diastolic blood pressure (DBP), heart rate, frequency of bone pain, weight of resected glands, preoperative serum calcium, intact parathyroid hormone (iPTH), alkaline phosphatase (ALP), and hemoglobin levels differed between the two groups. Binary logistic regression analyses identified preoperative serum calcium, iPTH, and ALP levels as independent predictors of SH after surgery. Conclusions The preoperative serum calcium, iPTH, and ALP levels can be used to assess the risk of postoperative SH in patients with SHPT. Such patients should thus be monitored closely in order to initiate prompt interventions to avoid SH.
Highlights
Secondary hyperparathyroidism (SHPT) is a major chronic complication in patients undergoing maintenance hemodialysis and is correlated with morbidity and mortality
The expensive price limited the application of cinacalcet. erefore, parathyroidectomy remains a valuable and useful method to treat severe secondary hyperparathyroidism (SHPT), in patients who are resistant to medical treatments or who cannot afford expensive agents
Indications for parathyroidectomy included at least one of the follows: (1) severe SHPT resistant to medical therapy with calcitriol or vitamin D analogs, (2) severe SHPT with hyperphosphatemia (>2.0 mmol/L), (3) severe SHPT with unbearable pruritus and/or bone pain, and (4) imagological examination showing hyperplasia of the parathyroid glands (>1.0 cm in diameter). e study was approved by the ethical committee of the Second Affiliated Hospital of Nanjing Medical University and informed consent was obtained from all the patients
Summary
Hypocalcemia is the most common complication of total parathyroidectomy in secondary hyperparathyroidism (SHPT) and is associated with adverse consequences such as spasms, epilepsy, and arrhythmia and even death if the serum calcium level decreases rapidly. Previous studies have identified several risk factors for postoperative severe hypocalcemia (SH) in patients with SHPT, but the sample sizes were small and the results may not be reliable. Is study was performed to investigate the risk factors for SH after total parathyroidectomy without autotransplantation (tPTX) in a large sample of patients with uremic hyperparathyroidism. Binary logistic regression analyses identified preoperative serum calcium, iPTH, and ALP levels as independent predictors of SH after surgery. E preoperative serum calcium, iPTH, and ALP levels can be used to assess the risk of postoperative SH in patients with SHPT. Such patients should be monitored closely in order to initiate prompt interventions to avoid SH
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