Predictors of Early Postoperative Hypocalcemia in Hemodialysis Patients With Secondary Hyperparathyroidism

We sought to investigate predictors of early development of postoperative hypocalcemia in secondary hyperparathyroidism. Thirty-six hemodialysis patients (21 men, 15 women; mean age, 39.6 ± 13.2 years; mean hemodialysis duration, 77.9 ± 47.1 months) underwent parathyroidectomy. We recorded preoperative adjusted serum calcium (Ca⁺²), phosphate, alkaline phosphatase, intact parathyroid hormone, and hemoglobin levels; mean systolic and diastolic blood pressure levels; parathyroid ultrasonography and scintigraphic data; and number and weight of the resected adenomas. Patients were divided into two groups based on Ca⁺² levels within 24 hours of parathyroidectomy: the hypocalcemia group (serum Ca⁺² levels ≤ 8 mg/dL; n = 26 patients) and the normocalcemia group (>8 mg/dL; n = 10 patients). A total parathyroidectomy with autotransplant was performed in 23 patients and a subtotal parathyroidectomy in 13 patients. Age (36.0 ± 9.7 vs 49.2 ± 16.6 years; P = .006); levels of preoperative serum Ca⁺² (9.6 ± 0.7 vs 10.4 ± 1.1 mg/dL; P = .01), alkaline phosphatase (346.7 ± 354.7 vs 653.3 ± 553.7 mg/dL; P = .05), and hemoglobin (10.5 ± 1.4 vs 12.3 ± 2.5 g/dL; P = .009); and number (2.0 ± 1.3 vs 2.9 ± 0.9; P = .04) and weight (1.9 ± 2.1 vs 3.2 ± 1.7; P = .01) of excised parathyroid adenomas were significantly lower among the hypocalcemia than the normocalcemia group. Among hemodialysis patients with secondary hyperparathyroidism, age, levels of preoperative serum Ca⁺² and alkaline phosphatase, and number and weight of adenomas were associated with early development of postoperative hypocalcemia.