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Predictors of early postoperative hypocalcemia after total parathyroidectomy in renal hyperparathyroidism

Annals of Surgical Treatment and Research 2020년 98권 1호 p.1 ~ 6
 ( Tan Poh Guan ) - Universiti Sains Malaysia School of Medical Sciences Department of Surgery

 ( Hadi Imi Sairi Ab. ) - Hospital Raja Perempuan Zainab 2 Department of Surgery
 ( Zahari Zalina ) - Universiti Sultan Zainal Abidin Faculty of Pharmacy
 ( Yahya Maya Mazuwin ) - Universiti Sains Malaysia School of Medical Sciences Department of Surgery
 ( Zain Wan Zainira Wan ) - Universiti Sains Malaysia School of Medical Sciences Department of Surgery
 ( Wong Michael Pak-Kai ) - Universiti Sains Malaysia School of Medical Sciences Department of Surgery
 ( Ramely Rosnelifaizur ) - Universiti Sains Malaysia School of Medical Sciences Department of Surgery
 ( Hashim Mohd Nizam Md ) - Universiti Sains Malaysia School of Medical Sciences Department of Surgery
 ( Aziz Syed Hassan Syed Abd. ) - Universiti Sains Malaysia School of Medical Sciences Department of Surgery
 ( Zakaria Zaidi ) - Universiti Sains Malaysia School of Medical Sciences Department of Surgery
 ( Zakaria Andee Dzulkarnaen ) - Universiti Sains Malaysia School of Medical Sciences Department of Surgery

Abstract


Purpose: Patients with secondary hyperparathyroidism are at high risk for developing postoperative hypocalcemia. However, there are limited data regarding predictors of postoperative hypocalcemia in renal failure patient with secondary hyperparathyroidism. This study aimed to determine the clinical presentations of renal hyperparathyroidism and the predictors of early postoperative hypocalcemia after total parathyroidectomy.

Methods: Data of patients with renal hyperparathyroidism who underwent total parathyroidectomy between January 2007 to December 2014 were reviewed retrospectively. Patients were divided into 2 cohort groups according to their serum calcium levels within 24 hours of parathyroidectomy: the hypocalcemia group (calcium levels of 2 mmol/L or less), and the normocalcemia group (calcium levels more than 2 mmol/L). With the use of multivariable logistic regression analyses, the predictors of early postoperative hypocalcemia after total parathyroidectomy in patients with renal hyperparathyroidism were investigated.

Results: Among 68 patients, 56 patients (82.4%) were symptomatic preoperatively. Fifty patients (73.5%) presented with bone pain and 14 patients (20.6%) had muscle weakness. Early postoperative hypocalcemia occurred in 25 patients (36.8%). Preoperative alkaline phosphatase level was the predictor of early postoperative hypocalcemia (adjusted odds ratio, 1.004; 95% confidence interval, 1.001?1.006; P = 0.002).

Conclusion: Results from our study show that most of the patients with renal hyperparathyroidism were symptomatic preoperatively and the most common clinical presentations were bone pain and muscle weakness. The significant predictor of early postoperative hypocalcemia after total parathyroidectomy was the preoperative alkaline phosphatase levels.

키워드

Hypocalcemia; Parathyroidectomy; Parathyroid hormone; Renal insufficiency; Secondary hyperparathyroidism
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