Persisting Hypocalcemia After Surgical Parathyroidectomy: The Differential Effectiveness of Calcium Citrate Versus Calcium Carbonate With Acid Suppression

Targeted surgical parathyroidectomy in end‐stage renal disease patients and long‐term metabolic control: A single‐center experience in the current era

“…56 Some of these patients may have hypocalcemia due to impaired calcium absorption from CaCO3 with achlorhydria; for them, calcium from calcium-citrate or calcium gluconate are more easily bioavailable. 57 Anecdotally, we have also observed several individuals in our unit with an unexplained tendency for hypophosphatemia (hypophosphatemia or normal phosphors without a phosphorus binder on board) and a "normal" PTH level (150-400 pg/ mL). Further inquiry revealed a distant history of surgical PTX for ESRD-associated hyperparathyroidism in all of the reviewed cases (unpublished observations of the Authors).…”

“…58 PD patients will be dependent on both the intake and intact absorption of exogenous calcium and VDA to maintain calcium at acceptable levels. 57 Our study has several obvious limitations. First, it is derived from a relatively small cohort with a single-center design.…”

“…The temporary use of synthetic subcutaneous PTH analog therapy has only been reported anecdotally and has not been formally studied in renal patients . Some of these patients may have hypocalcemia due to impaired calcium absorption from CaCO3 with achlorhydria; for them, calcium from calcium‐citrate or calcium gluconate are more easily bioavailable . Anecdotally, we have also observed several individuals in our unit with an unexplained tendency for hypophosphatemia (hypophosphatemia or normal phosphors without a phosphorus binder on board) and a “normal” PTH level (150–400 pg/mL).…”

“…Therefore, assuming an identical amount of calcium deposition after PTX, there may be a disproportionate tendency for hypocalcemia after PTX in patients undergoing peritoneal dialysis . PD patients will be dependent on both the intake and intact absorption of exogenous calcium and VDA to maintain calcium at acceptable levels …”

Assessment of Inorganic Phosphate Intake by the Measurement of the Phosphate/Urea Nitrogen Ratio in Urine

“…A high P load may be associated with a decrease in serum bicarbonate level, unfortunately serum bicarbonate was not measured. Moreover, it was not taken into account that patients on proton-pump inhibitors may have changed the intestinal absorption of P [43,44]. An important limitation of this type of study is the difficulty of a precise calculation of the P content in the diet despite a conscious training of patients in how to complete the dietary survey.…”