Analysis Of Risk Factors Of Severe Hypocalcemia In Patients With Refractory Renal Hyperparathyroidism After Parathyroidectomy

ObjectiveTo explore the incidence and risk factors of severe hypocalcemia in patients with refractory renal secondary hyperparathyroidism after parathyroidectomy.MethodsA retrospective study was conducted in 784 patients with refractory renal secondary hyperparathyroidism who underwent parathyroidectomy+ auto-transplantation or parathyroidectomy.Statistical analysis was performed by using SPSS 23.0 software.Mann-Whitney test was used to compare the level of serum calcium,serum phosphorus and serum parathyroid hormone before and after parathyroidectomy.Patients were divided into severe hypocalcemia group（serum corrected calcium<1.8 mmol/L）and non-severe hypocalcemia group（serum corrected calcium≥1.8 mmol/L）according to serum calcium level on the first day after parathyroidectomy.Risk factors of severe hypocalcemia were analyzed by using t test or nonparametric test.Binary Logistic model were employed for multiple factors analysis.ResultsIn patients with secondary hyperparathyroidism,calcium,phosphorus and parathyroid hormone decreased after parathyroidectomy（P<0.05）.The operation with postoperative PTH reduction rate>50%was considered successful,and the operation success rate was 98.60%in this study.The incidence of severe hypocalcemia within24hours after parathyroidectomy was 27.3%.Age（t=5.648,P<0.001）,dialysis age>5years（z=7.199,P=0.007）,peritoneal dialysis（（?）~2=4.985,P=0.026）,preoperative relatively low serum corrected calcium（（?）~2=6.241,P=0.012）,preoperative PTH level（z=-8.902,P<0.001）,preoperative alkaline phosphatase level（z=-10.230,P<0.001）and postoperative serum phosphorus with reached the standard（（?）~2=3.988,P=0.046）,the differences were statistically significant between the non-severe hypocalcemia group and the severe hypocalcemia group.In the multivariate analysis,younger age （OR=0.963,P<0.001）,preoperative relatively low serum corrected calcium（OR=1.930,P=0.018）,higher preoperative PTH level（OR=1.0004,P=0.016）and higher preoperative alkaline phosphatase level（OR=1.001,P=0.001）were independent risk factors.ConclusionPatients with younger age,preoperative relatively low serum corrected calcium,higher preoperative alkaline phosphatase,and higher preoperative parathyroid hormone levels are more likely to develop severe hypocalcemia after parathyroidectomy+autologous transplantation or parathyroidectomy.