The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지
DOI QR코드

DOI QR Code

Predicting postoperative total calcium requirements after parathyroidectomy in secondary hyperparathyroidism

  • Kang, Byung Heon (Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine) ;
  • Hwang, Soon Young (Department of Biostatistics, Korea University College of Medicine) ;
  • Kim, Jeong Yeop (Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine) ;
  • Hong, Yu Ah (Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine) ;
  • Jung, Mi Yeon (Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine) ;
  • Lee, Eun Ah (Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine) ;
  • Lee, Ji Eun (Division of Nephrology, Department of Internal Medicine, Hallym University College of Medicine) ;
  • Lee, Jae Bok (Division of Breast and Endocrine Surgery, Department of Surgery, Korea University College of Medicine) ;
  • Ko, Gang Jee (Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine) ;
  • Pyo, Heui Jung (Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine) ;
  • Kwon, Young Joo (Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine)
  • Received : 2013.07.19
  • Accepted : 2014.05.11
  • Published : 2015.11.01
⟨ Previous Next ⟩

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 ${\Delta}$phosphorus at 48 hours (p < 0.001). We developed an equation for estimating the total calcium requirement after PTX. Conclusions: Preoperative ALP, preoperative iPTH, and ${\Delta}$phosphorus 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.

Keywords

References

  1. Glassford DM, Remmers AR Jr, Sarles HE, Lindley JD, Scurry MT, Fish JC. Hyperparathyroidism in the maintenance dialysis patient. Surg Gynecol Obstet 1976;142:328-332.
  2. Higgins RM, Richardson AJ, Ratcliffe PJ, Woods CG, Oliver DO, Morris PJ. Total parathyroidectomy alone or with autograft for renal hyperparathyroidism? Q J Med 1991;79:323-332.
  3. Akizawa T, Fukagawa M, Koshikawa S, Kurokawa K. Recent progress in management of secondary hyperparathyroidism of chronic renal failure. Curr Opin Nephrol Hypertens 1993;2:558-565. https://doi.org/10.1097/00041552-199307000-00006
  4. Hruska KA, Teitelbaum SL. Renal osteodystrophy. N Engl J Med 1995;333:166-174. https://doi.org/10.1056/NEJM199507203330307
  5. Yudd M, Llach F. Current medical management of secondary hyperparathyroidism. Am J Med Sci 2000;320:100-106. https://doi.org/10.1097/00000441-200008000-00007
  6. Stracke S, Keller F, Steinbach G, Henne-Bruns D, Wuerl P. Long-term outcome after total parathyroidectomy for the management of secondary hyperparathyroidism. Nephron Clin Pract 2009;111:c102-c109. https://doi.org/10.1159/000191200
  7. Tominaga Y, Numano M, Tanaka Y, Uchida K, Takagi H. Surgical treatment of renal hyperparathyroidism. Semin Surg Oncol 1997;13:87-96. https://doi.org/10.1002/(SICI)1098-2388(199703/04)13:2<87::AID-SSU4>3.0.CO;2-Y
  8. Tominaga Y, Uchida K, Haba T, et al. More than 1,000 cases of total parathyroidectomy with forearm autograft for renal hyperparathyroidism. Am J Kidney Dis 2001;38(4 Suppl 1):S168-S171. https://doi.org/10.1053/ajkd.2001.27432
  9. Park JH, Kang SW, Jeong JJ, et al. Surgical treatment of tertiary hyperparathyroidism after renal transplantation: a 31-year experience in a single institution. Endocr J 2011;58:827-833. https://doi.org/10.1507/endocrj.EJ11-0053
  10. Goldfarb M, Gondek SS, Lim SM, Farra JC, Nose V, Lew JI. Postoperative hungry bone syndrome in patients with secondary hyperparathyroidism of renal origin. World J Surg 2012;36:1314-1319. https://doi.org/10.1007/s00268-012-1560-x
  11. Goh BL, Yudisthra MG, Hisham AN. Alkaline phosphatase predicts calcium requirements after total parathyroidectomy in patients receiving dialysis. Br J Surg 2010;97:185-188. https://doi.org/10.1002/bjs.6818
  12. Norman JG, Politz DE. Safety of immediate discharge after parathyroidectomy: a prospective study of 3,000 consecutive patients. Endocr Pract 2007;13:105-113. https://doi.org/10.4158/EP.13.2.105
  13. Cheong YT, Taib NA, Normayah K, Hisham AN. Total parathyroidectomy under local anaesthesia for renal hyperparathyroidism. Asian J Surg 2009;32:51-54. https://doi.org/10.1016/S1015-9584(09)60009-9
  14. Schlosser K, Veit JA, Witte S, et al. Comparison of total parathyroidectomy without autotransplantation and without thymectomy versus total parathyroidectomy with autotransplantation and with thymectomy for secondary hyperparathyroidism: TOPAR PILOT-Trial. Trials 2007;8:22. https://doi.org/10.1186/1745-6215-8-22
  15. Melck AL, Carty SE, Seethala RR, et al. Recurrent hyperparathyroidism and forearm parathyromatosis after total parathyroidectomy. Surgery 2010;148:867-873. https://doi.org/10.1016/j.surg.2010.07.037
  16. Henry JF, Denizot A, Audiffret J, France G. Results of reoperations for persistent or recurrent secondary hyperparathyroidism in hemodialysis patients. World J Surg 1990;14:303-306. https://doi.org/10.1007/BF01658510
  17. Saunders RN, Karoo R, Metcalfe MS, Nicholson ML. Four gland parathyroidectomy without reimplantation in patients with chronic renal failure. Postgrad Med J 2005;81:255-258. https://doi.org/10.1136/pgmj.2004.026450
  18. Ljutic D, Cameron JS, Ogg CS, Turner C, Hicks JA, Owen WJ. Long-term follow-up after total parathyroidectomy without parathyroid reimplantation in chronic renal failure. QJM 1994;87:685-692.
  19. Hargrove GM, Pasieka JL, Hanley DA, Murphy MB. Shortand long-term outcome of total parathyroidectomy with immediate autografting versus subtotal parathyroidectomy in patients with end-stage renal disease. Am J Nephrol 1999;19:559-564. https://doi.org/10.1159/000013520
  20. Farrington K, Varghese Z, Chan MK, et al. How complete is a total parathyroidectomy in uraemia? Br Med J (Clin Res Ed) 1987;294:743. https://doi.org/10.1136/bmj.294.6574.743
  21. Conzo G, Perna AF, Sinisi AA, et al. Total parathyroidectomy without autotransplantation in the surgical treatment of secondary hyperparathyroidism of chronic kidney disease. J Endocrinol Invest 2012;35:8-13.
  22. Puccini M, Carpi A, Cupisti A, et al. Total parathyroidectomy without autotransplantation for the treatment of secondary hyperparathyroidism associated with chronic kidney disease: clinical and laboratory long-term follow- up. Biomed Pharmacother 2010;64:359-362. https://doi.org/10.1016/j.biopha.2009.06.006
  23. Viaene L, Evenepoel P, Bammens B, Claes K, Kuypers D, Vanrenterghem Y. Calcium requirements after parathyroidectomy in patients with refractory secondary hyperparathyroidism. Nephron Clin Pract 2008;110:c80-c85. https://doi.org/10.1159/000151722
  24. Cheng SP, Liu CL, Chen HH, Lee JJ, Liu TP, Yang TL. Prolonged hospital stay after parathyroidectomy for secondary hyperparathyroidism. World J Surg 2009;33:72-79. https://doi.org/10.1007/s00268-008-9787-2

Cited by

  1. Total parathyroidectomy with forearm auto-transplantation improves the quality of life and reduces the recurrence of secondary hyperparathyroidism in chronic kidney disease patients vol.96, pp.49, 2015, https://doi.org/10.1097/md.0000000000009050
  2. Peripherally inserted central catheters for calcium requirements after successful parathyroidectomy: a comparison with centrally inserted catheters vol.99, pp.5, 2017, https://doi.org/10.1308/rcsann.2017.0004
  3. Factors associated with calcium requirements after parathyroidectomy in chronic kidney disease patients vol.50, pp.3, 2015, https://doi.org/10.1007/s11255-017-1759-8
  4. Serum parathyroid hormone and alkaline phosphatase as predictors of calcium requirements after total parathyroidectomy for hypocalcemia in secondary hyperparathyroidism vol.40, pp.2, 2018, https://doi.org/10.1002/hed.24965
  5. Hypocalcemia-based prediction of hungry bone syndrome after parathyroidectomy in hemodialysis patients with refractory secondary hyperparathyroidism vol.46, pp.12, 2018, https://doi.org/10.1177/0300060518788744
  6. Evaluation of laboratory parameters and symptoms after parathyroidectomy in dialysis patients with secondary hyperparathyroidism vol.41, pp.1, 2015, https://doi.org/10.1080/0886022x.2019.1666724
  7. Long‐term outcomes and management considerations after parathyroidectomy in the dialysis patient vol.32, pp.6, 2019, https://doi.org/10.1111/sdi.12833
  8. Parathyroidectomy in dialysis patients with secondary hyperparathyroidism, laboratory and clinical assessment vol.8, pp.4, 2020, https://doi.org/10.4103/ssj.ssj_66_21