Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 6, 2022; 10(13): 4033-4041
Published online May 6, 2022. doi: 10.12998/wjcc.v10.i13.4033
Effect of calcium supplementation on severe hypocalcemia in patients with secondary hyperparathyroidism after total parathyroidectomy
Jun Liu, Xue-Feng Fan, Meng Yang, Lin-Ping Huang, Ling Zhang
Jun Liu, Meng Yang, Lin-Ping Huang, Department of General Surgery, China-Japan Friendship Hospital, Beijing 100029, China
Xue-Feng Fan, Department of General Surgery, Shougang General Hospital, Shougang 553000, Guizhou Province, China
Ling Zhang, Department of Nephrology, China-Japan Friendship Hospital, Beijing 100029, China
Author contributions: Liu J, Yang M, and Fan XF carried out the studies, collected data, and drafted the manuscript; Liu J and Yang M performed the statistical analysis and critically reviewed the manuscript for important intellectual content; Huang LP and Zhang L participated in the acquisition, analysis, or interpretation of data and drafted the manuscript; and all authors read and approved the final manuscript.
Supported by the Subject of Beijing Science and Technology Plan, No. Z191100006619014.
Institutional review board statement: This work was carried out in accordance with the Declaration of Helsinki (2000) by the World Medical Association. The current retrospective study was approved by the institutional review board of China-Japan Friendship Hospital (2019-SDZL-12).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Meng Yang, MD, Doctor, Department of General Surgery, China-Japan Friendship Hospital, No. 2 East Yinghuayuan Street, Chaoyang District, Beijing 100029, China. hlpsurg406@sina.com
Received: March 31, 2021
Peer-review started: March 31, 2021
First decision: October 16, 2021
Revised: October 28, 2021
Accepted: April 9, 2022
Article in press: April 9, 2022
Published online: May 6, 2022
Processing time: 394 Days and 15 Hours
Abstract
BACKGROUND

Severe hypocalcemia (SH) is a dreaded complication of total parathyroidectomy (TPTX) without auto-transplantation.

AIM

To compare conventional and preventive calcium supplementation (CS) regimens in terms of SH occurrence after TPTX.

METHODS

This retrospective study included patients who underwent TPTX between January 2015 and May 2018 at the China-Japan Friendship Hospital. From January 2015 to May 2016, conventional CS was performed in patients who underwent TPTX, with calcium amounts adjusted according to postoperative serum calcium levels. From October 2016 to May 2018, preventive CS was performed according to preoperative alkaline phosphatase (ALP) levels. The patients were defined as low-risk (ALP < 500 U/L) and high-risk (ALP > 500 U/L) for SH. All preoperative blood samples were collected in the fasting state on the day before surgery. Postoperative blood samples were obtained at 6-7 AM from the first postoperative day.

RESULTS

A total of 271 patients were included. These patients were 47.7 ± 11.1 years old, and 57.6% were male. Their mean body mass index (BMI) was 22.9 ± 3.8 kg/m2. There were no significant differences in sex, age, BMI, preoperative ALP, serum calcium, serum phosphorus, calcium-phosphorus ratio, and intact parathyroid hormone (iPTH) between the two CS groups. Compared with conventional CS, preventive CS led to lower occurrence rates of hypocalcemia within 48 h (46.0% vs 74.5%, P < 0.001) and SH (31.7% vs 64.1%, P < 0.001). Multivariable analysis showed that preoperative iPTH levels [odds ratio (OR) = 1.001, 95% confidence interval (CI): 1.000-1.001, P = 0.009), preoperative ALP amounts (OR = 1.002, 95%CI: 1.001-1.003, P = 0.002), preoperative serum phosphorus levels (OR = 8.729, 95%CI: 1.518-50.216, P = 0.015) and preventive CS (OR = 0.132, 95%CI: 0.067-0.261, P < 0.001) were independently associated with SH. In patients with preoperative ALP ≥ 500 U/L, only preventive CS (OR = 0.147, 95%CI: 0.038-0.562. P = 0.005) was independently associated with SH.

CONCLUSION

This study suggests that preventive CS could reduce the occurrence of SH, indicating its critical value for hypocalcemia after TPTX.

Keywords: End-stage renal disease; Secondary hyperparathyroidism; Parathyroidectomy; Hypocalcemia; Calcium supplementation

Core Tip: Compared with conventional calcium supplementation (CS), preventive CS led to lower occurrence rates of hypocalcemia within 48 h and severe hypocalcemia (SH). Multivariable analysis showed that preoperative intact parathyroid hormone levels, preoperative alkaline phosphatase (ALP) amounts, preoperative serum phosphorus levels, and preventive CS were independently associated with SH. In patients with preoperative ALP > 500 U/L, only preventive CS was independently associated with SH.