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Risk factors for severe hypocalcemia after parathyroidectomy in prevalent dialysis patients with secondary hyperparathyroidism

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Abstract

Purpose

Hypocalcemia is one of the common complications after parathyroidectomy (PTX). Severe hypocalcemia (SH) can lead to tetany, cardiac arrhythmia and even sudden death. However, predictors for the development of SH in patients with secondary hyperparathyroidism demonstrated in some small-scale studies with a limited sample size remain inconclusive.

Methods

A retrospective chart review of 420 consecutive dialysis patients who underwent PTX during a 12-year period was performed. We checked serum levels of calcium (Ca), phosphorus (P), alkaline phosphatase (ALP) and intact parathyroid hormone (iPTH) for three consecutive days postoperatively. SH was defined as the minimum values of serum calcium lower than 1.875 mmol/L (7.5 mg/dL) within 3 days after operation.

Results

The mean (±SD) age of our study population was 53 ± 12 years, and more than half (57 %) were female. SH occurred in 37 % of the patients after PTX. Using a multivariate stepwise logistic regression analysis, lower preoperative levels of Ca (odds ratio 0.69, 95 % CI 0.60–0.79, P < 0.001), higher preoperative levels of iPTH (odds ratio 1.04, 95 % CI 1.00–1.07, P = 0.048), P (odds ratio 2.43, 95 % CI 1.49–3.95, P < 0.001) and ALP (odds ratio 1.08, 95 % CI 1.05–1.11, P < 0.001) were found to be independent predictors of occurrence of SH following PTX.

Conclusions

The readily obtainable preoperative laboratory parameters including Ca, iPTH, P, and ALP will allow identification of a subgroup of patients who are at greater risk for the development of SH following PTX.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Correspondence to Hung-Yuan Chen.

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Tsai, W., Peng, Y., Chiu, Y. et al. Risk factors for severe hypocalcemia after parathyroidectomy in prevalent dialysis patients with secondary hyperparathyroidism. Int Urol Nephrol 47, 1203–1207 (2015). https://doi.org/10.1007/s11255-015-1016-y

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Keywords

  • Alkaline phosphatase
  • Hypocalcemia
  • Parathyroidectomy
  • Parathyroid hormone
  • Phosphorus