Predicting postoperative total calcium requirements after parathyroidectomy in secondary hyperparathyroidism.
10.3904/kjim.2015.30.6.856
- Author:
Byung Heon KANG
1
;
Soon Young HWANG
;
Jeong Yeop KIM
;
Yu Ah HONG
;
Mi Yeon JUNG
;
Eun Ah LEE
;
Ji Eun LEE
;
Jae Bok LEE
;
Gang Jee KO
;
Heui Jung PYO
;
Young Joo KWON
Author Information
1. Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea. yjkwon@korea.ac.kr
- Publication Type:Original Article
- Keywords:
Hyperparathyroidism;
Secondary;
Parathyroidectomy;
Kidney failure, chronic
- MeSH:
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
- From:The Korean Journal of Internal Medicine
2015;30(6):856-864
- CountryRepublic of Korea
- Language:English
-
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.
