Risk Factors for Severe Hypocalcemia in Patients with Secondary Hyperparathyroidism after Total Parathyroidectomy

Ping Wen; Lingling Xu; Shasha Zhao; Wei Gan; Dawei Hou; Liang Zhang; Jinlong Cao; Mingxia Xiong; Lei Jiang; Junwei Yang

doi:10.1155/2021/6613659

Risk Factors for Severe Hypocalcemia in Patients with Secondary Hyperparathyroidism after Total Parathyroidectomy

Int J Endocrinol. 2021 Apr 2:2021:6613659. doi: 10.1155/2021/6613659. eCollection 2021.

Authors

Ping Wen¹, Lingling Xu¹, Shasha Zhao¹, Wei Gan¹, Dawei Hou², Liang Zhang¹, Jinlong Cao¹, Mingxia Xiong¹, Lei Jiang¹, Junwei Yang¹

Affiliations

¹ Center for Kidney Disease, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China.
² Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China.

Abstract

Background: Hypocalcemia is the most common complication of total parathyroidectomy in secondary hyperparathyroidism (SHPT) and is associated with adverse consequences such as spasms, epilepsy, and arrhythmia and even death if the serum calcium level decreases rapidly. Previous studies have identified several risk factors for postoperative severe hypocalcemia (SH) in patients with SHPT, but the sample sizes were small and thus the results may not be reliable.

Objectives: This study was performed to investigate the risk factors for SH after total parathyroidectomy without autotransplantation (tPTX) in a large sample of patients with uremic hyperparathyroidism.

Methods: We retrospectively investigated the records of 1,095 patients with SHPT treated with tPTX between January 2008 and December 2018. Based on the postoperative serum calcium concentration, the patients were grouped into SH and non-SH groups. The clinical characteristics and biochemical results were analyzed, and binary logistic regression analysis was used to identify the risk factors for SH.

Results: After surgery, 25.9% of the patients developed SH. Age, diastolic blood pressure (DBP), heart rate, frequency of bone pain, weight of resected glands, preoperative serum calcium, intact parathyroid hormone (iPTH), alkaline phosphatase (ALP), and hemoglobin levels differed between the two groups. Binary logistic regression analyses identified preoperative serum calcium, iPTH, and ALP levels as independent predictors of SH after surgery.

Conclusions: The preoperative serum calcium, iPTH, and ALP levels can be used to assess the risk of postoperative SH in patients with SHPT. Such patients should thus be monitored closely in order to initiate prompt interventions to avoid SH.