title: Predicting postoperative total calcium requirements after parathyroidectomy in secondary hyperparathyroidism.
abstract: OBJECTIVE
  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.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
authors.forename: Byung Heon
authors.initials: BH
authors.lastname: Kang
authors.affiliation: Department of Biostatistics, Korea University College of Medicine, Seoul, Korea.
authors.forename: Soon Young
authors.initials: SY
authors.lastname: Hwang
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
authors.forename: Jeong Yeop
authors.initials: JY
authors.lastname: Kim
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
authors.forename: Yu Ah
authors.initials: YA
authors.lastname: Hong
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
authors.forename: Mi Yeon
authors.initials: MY
authors.lastname: Jung
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
authors.forename: Eun Ah
authors.initials: EA
authors.lastname: Lee
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea.
authors.forename: Ji Eun
authors.initials: JE
authors.lastname: Lee
authors.affiliation: Division of Breast and Endocrine Surgery, Department of Surgery, Korea University College of Medicine, Seoul, Korea.
authors.forename: Jae Bok
authors.initials: JB
authors.lastname: Lee
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
authors.forename: Gang Jee
authors.initials: GJ
authors.lastname: Ko
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
authors.forename: Heui Jung
authors.initials: HJ
authors.lastname: Pyo
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
authors.forename: Young Joo
authors.initials: YJ
authors.lastname: Kwon
mesh_terms: D061605:Administration, Intravenous; D000284:Administration, Oral; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002118:Calcium / Q000097:blood; D002119:Calcium Carbonate / Q000008:administration & dosage*; D017610:Calcium Compounds / Q000008:administration & dosage*; D002125:Calcium Gluconate / Q000008:administration & dosage*; D003661:Decision Support Techniques; D019587:Dietary Supplements; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000097:blood / Q000175:diagnosis / Q000601:surgery*; D006996:Hypocalcemia / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D007773:Lactates / Q000008:administration & dosage*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D015999:Multivariate Analysis; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy / Q000009:adverse effects*; D010758:Phosphorus / Q000097:blood; D012008:Recurrence; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers; D017610:Calcium Compounds; D007773:Lactates; C470125:PTH protein, human; D010281:Parathyroid Hormone; D010758:Phosphorus; C110051:calcium lactate; D002119:Calcium Carbonate; D002125:Calcium Gluconate; D002118:Calcium
keywords: Hyperparathyroidism; Kidney failure, chronic; Parathyroidectomy; Secondary