title: Risk factors for severe hypocalcemia after parathyroidectomy in prevalent dialysis patients with secondary hyperparathyroidism.
abstract: OBJECTIVE
  Hypocalcemia is one of the common complications after parathyroidectomy (PTX). Severe hypocalcemia (SH) can lead to tetany, cardiac arrhythmia and even sudden death. However, predictors for the development of SH in patients with secondary hyperparathyroidism demonstrated in some small-scale studies with a limited sample size remain inconclusive.
  
  
  METHODS
  A retrospective chart review of 420 consecutive dialysis patients who underwent PTX during a 12-year period was performed. We checked serum levels of calcium (Ca), phosphorus (P), alkaline phosphatase (ALP) and intact parathyroid hormone (iPTH) for three consecutive days postoperatively. SH was defined as the minimum values of serum calcium lower than 1.875 mmol/L (7.5 mg/dL) within 3 days after operation.
  
  
  RESULTS
  The mean (±SD) age of our study population was 53 ± 12 years, and more than half (57 %) were female. SH occurred in 37 % of the patients after PTX. Using a multivariate stepwise logistic regression analysis, lower preoperative levels of Ca (odds ratio 0.69, 95 % CI 0.60-0.79, P < 0.001), higher preoperative levels of iPTH (odds ratio 1.04, 95 % CI 1.00-1.07, P = 0.048), P (odds ratio 2.43, 95 % CI 1.49-3.95, P < 0.001) and ALP (odds ratio 1.08, 95 % CI 1.05-1.11, P < 0.001) were found to be independent predictors of occurrence of SH following PTX.
  
  
  CONCLUSIONS
  The readily obtainable preoperative laboratory parameters including Ca, iPTH, P, and ALP will allow identification of a subgroup of patients who are at greater risk for the development of SH following PTX.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Far Eastern Memorial Hospital, No. 21, Section 2, Nanya South Road, Banqiao District, New Taipei City, 220, Taiwan, Republic of China.
authors.forename: Wan-Chuan
authors.initials: WC
authors.lastname: Tsai
authors.forename: Yu-Sen
authors.initials: YS
authors.lastname: Peng
authors.forename: Yen-Ling
authors.initials: YL
authors.lastname: Chiu
authors.forename: Hon-Yen
authors.initials: HY
authors.lastname: Wu
authors.forename: Mei-Fen
authors.initials: MF
authors.lastname: Pai
authors.forename: Shih-Ping
authors.initials: SP
authors.lastname: Hsu
authors.forename: Ju-Yeh
authors.initials: JY
authors.lastname: Yang
authors.forename: Kuei-Ting
authors.initials: KT
authors.lastname: Tung
authors.forename: Hung-Yuan
authors.initials: HY
authors.lastname: Chen
mesh_terms: D000328:Adult; D000469:Alkaline Phosphatase / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002118:Calcium / Q000097:blood*; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000097:blood / Q000209:etiology / Q000601:surgery; D006996:Hypocalcemia / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood*; D016105:Parathyroidectomy / Q000009:adverse effects* / Q000379:methods; D010758:Phosphorus / Q000097:blood*; D011237:Predictive Value of Tests; D057234:Preoperative Period; D011379:Prognosis; D006435:Renal Dialysis / Q000379:methods; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000628:therapy; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D010281:Parathyroid Hormone; D010758:Phosphorus; D000469:Alkaline Phosphatase; D002118:Calcium