Predicting postoperative total calcium requirements after parathyroidectomy in secondary hyperparathyroidism

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 Δphosphorus at 48 hours (p < 0.001). We developed an equation for estimating the total calcium requirement after PTX.Conclusions:Preoperative ALP, preoperative iPTH, and Δphosphorus 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.

Serum parathyroid hormone and alkaline phosphatase as predictors of calcium requirements after total parathyroidectomy for hypocalcemia in secondary hyperparathyroidism

“…The cutoff point may help to prevent hypocalcemia by predicting insufficient calcium supplements when patients have been administrated calcium as per the formula protocol. The formula for the postoperative calcium requirement after parathyroidectomy contributes to preventing prolonged hypocalcemia safely . In the present study, the first equation was helpful for the calcium supplements to prevent hypocalcemia in the second phase.…”

“…Thus, the prediction of total calcium requirement after parathyroidectomy becomes important for decreasing the duration of the hospital stay and calcium balance. Few studies showed that the preoperative alkaline phosphatase level and the PTH level could be used to predict the total elemental calcium requirement after parathyroidectomy . The amount of calcium supplement and baseline characteristics showed wide differences among the studies, including the operation, preoperative serum PTH levels, and serum alkaline phosphatase levels (Table ).…”

“…The amount of calcium supplement and baseline characteristics showed wide differences among the studies, including the operation, preoperative serum PTH levels, and serum alkaline phosphatase levels (Table ). In the present study, the calcium supplement dose is similar to Kang et al study, depending on the relationship between the amount of calcium supplement and the alkaline phosphatase and PTH levels. Because calcium malabsorption in patients with renal failure led to unreliable serum calcium levels control through oral calcium compounds, the calcium supplements were totally administered intravenously in this study …”

“…Serum alkaline phosphatase and parathyroid hormone (PTH) may be useful in determining the amount of calcium requirement after parathyroidectomy. There are differences in the amount of administration of calcium supplement, predictor variables, and patients baseline between these studies . In the present study, we investigated the correlation between the amount of calcium supplement and predictable parameters (alkaline phosphatase level and PTH) for calcium requirement in patients with hypocalcemia.…”

Peripherally inserted central catheters for calcium requirements after successful parathyroidectomy: a comparison with centrally inserted catheters

“…Of note, Byung et al reported that preoperative alkaline phosphatase, preoperative intact parathyroid hormone and phosphorus at 48 hours may be significant factors in estimating the postoperative calcium requirement after parathyroidectomy. 36 However, Goldfarbyoung et al pointed out that the only identifiable preoperative risk factor for hungry bone syndrome was young age. 33 According to the pathophysiological mechanism, post-parathyroidectomy hypocalcaemia is an increased shift of calcium from the circulation to the bone tissues.…”