Risk factors for hypocalcemia in dialysis patients with refractory secondary hyperparathyroidism after parathyroidectomy: a meta-analysis

Abstract

Objective Hypocalcemia after parathyroidectomy (PTX) results in tetany, diarrhea, cardiac arrhythmia, and even sudden death. However, a meta-analysis or systematic evaluation of risk factors with the occurrence and development of hypocalcemia in patients with secondary hyperparathyroidism (SHPT) after PTX has never been performed. Methods A thorough search of electronic databases, including PubMed, Web of Science, the Cochrane Library, and EMBASE, was performed to retrieve relevant studies from database inception to June 2021. Quality of the included studies was assessed by two independent reviewers using the Newcastle–Ottawa Scale. Review Manager 5.3 and Stata 16.0 were used for meta-analysis. The random-effects model was adopted to calculate the 95% CIs ( I 2 > 50% or p < 0.05) of the combined effect size and the corresponding homogeneous data. Otherwise, a fixed-effects model was used. Results Thirteen studies including 2990 participants who met the inclusion criteria were enrolled in the present meta-analysis. The overall quality of the enrolled studies had a score of >7 points. Risk factors significantly related to hypocalcemia in patients with SHPT after PTX were preoperative serum calcium (OR 0.19, 95%CI 0.11–0.31), preoperative alkaline phosphatase (ALP) (OR 1.01, 95% CI 1.01–1.02), and preoperative intact parathyroid hormone (iPTH) (OR 1.38, 95%CI 1.20–1.58). Meanwhile, age (OR 0.97, 95%CI 0.87–1.10) was not significantly correlated with hypocalcemia after PTX. Conclusions Based on the current evidence, preoperative serum calcium, preoperative ALP, and preoperative iPTH were significant predictors of hypocalcemia in patients with SHPT after PTX. More attention should be given to patients with these risk factors for the prevention of postoperative hypocalcemia.

Risk Factor Analysis and Prediction of Severe Hypocalcemia after Total Parathyroidectomy without Auto-Transplantation in Patients with Secondary Hyperparathyroidism

“…Younger age was found to be a preoperative risk factor for SH in this study, which is largely consistent with the previous reports [ 30 , 34 – 36 , 43 , 44 , 46 ]. Explanation as to why younger patients are at a higher risk of hypocalcemia mainly includes stronger osteoblast function and greater calcium utilization efficiency of bone tissue.…”

“…In previous studies, preoperative iPTH as one of the risk factors of postoperative hypocalcemia has been frequently found in patients who underwent PTX [ 29 , 31 – 34 , 36 , 37 , 39 , 40 , 43 , 44 ]. It is well accepted that preoperative iPTH concentration can be used to predict postoperative hypocalcemia, because it is consistent with the physiological functions of iPTH.…”

“…Importantly, we developed a nomogram which achieved an optimal preoperative prediction of SH in those patients who underwent TPTX without auto-transplantation for secondary hyperparathyroidism. Considering the high incidence of SH after parathyroidectomy and the development of life-threatening sequelae, eforts on the risk estimation of SH have been made over the past decade [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46]. Various risk factors have been suggested for the development of postoperative hypocalcemia in previous studies, including younger age, pruritus, higher preoperative iPTH and ALP levels, and lower preoperative serum calcium level.…”

Case report: Reoperative parathyroidectomy for large ectopic hyperplastic parathyroid in the mediastinum of a patient with recurrent secondary hyperparathyroidism

“…Postoperative management is also crucial for SHPT patients ( 20 , 21 ). This case shows that clinicians need to closely monitor patients' blood calcium to promptly discover and treat hypocalcemia ( 6 , 22 ). In recent years, the mode of multidisciplinary team (MDT) management has been introduced into the treatment of SHPT patients ( 23 , 24 ).…”

Factors influencing the development of bone starvation syndrome after total parathyroidectomy in patients with renal hyperparathyroidism

“…Additionally, preoperative ALP elevation was found to be a risk factor for postoperative HBS. Gong et al (12), Tsai et al (13) and Gao et al (14) showed in literature that age, preoperative calcium, ALP, and iPTH concentration are associated with HBS. Gong et al (12) reported that advanced age is a risk factor for postoperative HBS, but Jakubauskas et al (15) concluded that the younger the age, the higher the risk of HBS.…”