title: Young age, male sex, and end-stage renal disease with secondary hyperparathyroidism as risk factors for intraoperative hyperkalemia during parathyroidectomy.
abstract: OBJECTIVE
  The aim of this study was to investigate the risk factors of intraoperative hyperkalemia in end-stage renal disease patients undergoing parathyroidectomy (PTx) with autotransplantation (AT).
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Operating room of a tertiary care medical center.
  
  
  METHODS
  Thirty-two adult, American Society of Anesthesiologists physical status 2 and 3 patients with secondary hyperparathyroidism aged between 31 and 72 years scheduled for PTx with AT.
  
  
  METHODS
  Laboratory chemistries (intact parathyroid hormone, Na, K, Ca, P, arterial blood gas) were obtained before surgery and at 2 time points during surgery. The first chemistry levels during surgery were checked after the first 2 parathyroid glands had been removed, and the second levels were checked after wound closure. Statistical analysis was performed using t test, Fisher exact test, the receiver operating characteristic curve method, as appropriate.
  
  
  RESULTS
  Eight patients (25%) developed hyperkalemia during surgery. The hyperkalemia patients had younger age (42±11.44 years vs 52.58±11.83 years, P=.044) and a male dominance (odds ratio, 11.4; P=.01; 95% confidence interval, 1.74-74.65). The cutoff for age was 40.5 years, according to the highest value for sensitivity plus specificity of the receiver operating characteristic curve. There was a higher incidence of intraoperative hyperkalemia in younger patients than in older patients (odds ratio, 8.33; P=.023; 95% confidence interval, 1.39-49.87) as well as a significant increase in potassium level during surgery in younger male patients (P=.005 and .002, respectively).
  
  
  CONCLUSIONS
  The anesthesiologist should be aware of the complications of intraoperative hyperkalemia during PTx with AT, especially in male end-stage renal disease patients younger than 40 years.
authors.affiliation: Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC.
authors.forename: Ya-Ling
authors.initials: YL
authors.lastname: Yang
authors.affiliation: Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC.
authors.forename: Hsiao-Feng
authors.initials: HF
authors.lastname: Lu
authors.affiliation: Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC.
authors.forename: Kuan-Chih
authors.initials: KC
authors.lastname: Chung
authors.affiliation: Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC.
authors.forename: Bruno
authors.initials: B
authors.lastname: Jawan
authors.affiliation: Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC. Electronic address: inr453@adm.cgmh.org.tw.
authors.forename: Fong-Fu
authors.initials: FF
authors.lastname: Chou
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D006801:Humans; D006947:Hyperkalemia / Q000209:etiology*; D006962:Hyperparathyroidism, Secondary / Q000150:complications*; D007431:Intraoperative Complications / Q000209:etiology*; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D016105:Parathyroidectomy / Q000009:adverse effects*; D012307:Risk Factors; D012737:Sex Factors
keywords: Autotransplantation (AT); End-stage renal disease (ESRD); Hyperkalemia; Parathyroidectomy (PTx); Secondary hyperparathyroidism (SHPT)