Predicting postoperative total calcium requirements after parathyroidectomy in secondary hyperparathyroidism

Byung Heon Kang, Soon Young Hwang, Jeong Yeop Kim, Yu Ah Hong, Mi Yeon Jung, Eun Ah Lee, Ji Eun Lee, Jae Bok Lee, Gang Jee Ko, Heui Jung Pyo, Young-Joo Kwon

Research output: Contribution to journalArticle

8 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)856-864
Number of pages9
JournalKorean Journal of Internal Medicine
Volume30
Issue number6
DOIs
Publication statusPublished - 2015 Nov 1

Fingerprint

Parathyroidectomy
Secondary Hyperparathyroidism
Calcium
Autologous Transplantation
Parathyroid Hormone
Phosphorus
Alkaline Phosphatase
Hospitalization
Hypocalcemia
Calcitriol
Renal Dialysis
Linear Models
Regression Analysis
Recurrence

Keywords

  • Chronic
  • Hyperparathyroidism
  • Kidney failure
  • Parathyroidectomy
  • Secondary

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Predicting postoperative total calcium requirements after parathyroidectomy in secondary hyperparathyroidism. / Kang, Byung Heon; Hwang, Soon Young; Kim, Jeong Yeop; Hong, Yu Ah; Jung, Mi Yeon; Lee, Eun Ah; Lee, Ji Eun; Lee, Jae Bok; Ko, Gang Jee; Pyo, Heui Jung; Kwon, Young-Joo.

In: Korean Journal of Internal Medicine, Vol. 30, No. 6, 01.11.2015, p. 856-864.

Research output: Contribution to journalArticle

Kang, Byung Heon ; Hwang, Soon Young ; Kim, Jeong Yeop ; Hong, Yu Ah ; Jung, Mi Yeon ; Lee, Eun Ah ; Lee, Ji Eun ; Lee, Jae Bok ; Ko, Gang Jee ; Pyo, Heui Jung ; Kwon, Young-Joo. / Predicting postoperative total calcium requirements after parathyroidectomy in secondary hyperparathyroidism. In: Korean Journal of Internal Medicine. 2015 ; Vol. 30, No. 6. pp. 856-864.
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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.",
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AU - Kang, Byung Heon

AU - Hwang, Soon Young

AU - Kim, Jeong Yeop

AU - Hong, Yu Ah

AU - Jung, Mi Yeon

AU - Lee, Eun Ah

AU - Lee, Ji Eun

AU - Lee, Jae Bok

AU - Ko, Gang Jee

AU - Pyo, Heui Jung

AU - Kwon, Young-Joo

PY - 2015/11/1

Y1 - 2015/11/1

N2 - 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.

AB - 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.

KW - Chronic

KW - Hyperparathyroidism

KW - Kidney failure

KW - Parathyroidectomy

KW - Secondary

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