PREDICTORS OF HIGH CALCIUM REQUIREMENTS POST PARATHYROIDECTOMY IN PATIENT WITH HYPERPARATHYROIDISM RELATED TO END STAGE KIDNEY DISEASE; INFORMING THE NEED FOR HIGH DEPENDENCY UNIT ADMISSION POST-OPERATIVELY.

L WIEDERSEHN 1,  B ZAHOROWSKA 1, H HASSAN 4, S PRADHAN 3, R PETRUCCI 2, T PREDA 2, J WONG 1

1Department of Renal Medicine Liverpool Hospital, Liverpool, Australia, 2Department of Surgery Liverpool Hospital, Liverpool, Australia, 3Department of Breast, Endocrine, Head and Neck Surgery Liverpool Hospital, Liverpool, Australia, 4Department of Renal Medicine The Wollongong Hospital, Wollongong, Australia

Aim: To identify patients with high calcium requirements post parathyroidectomy in patient with hyperparathyroidism related to end stage kidney disease (rPTX) to help inform the need for high dependency unit (HDU) admissions post-operatively.

Background:  Without aggressive calcium replacement, patients undergoing rPTX are at risk of profound or prolonged hypocalcaemia. At Liverpool Hospital (LH) all patients are booked for admission to a HDU bed post-PTX. This approach is resource intensive and may delay surgery

Methods: We conducted a retrospective study of 312 patients who underwent parathyroidectomy during the study period January 2013-May 2020. Eighty-seven patients undergoing rPTX were identified. Comprehensive preoperative and postoperative biochemical variables, and prescribed oral/parenteral daily calcium supplementation were analysed with SPSS Statistics 1.0.0.1447. A threshold of Day 1 oral elemental calcium requirement >10,800mg was used to classify high risk patients.

Results: Median days from RFA provision to rPTX was 137.5days (IQR 214). The median HDU stay was 2 days (IQR 1-3). Peak intravenous calcium requirement occurred on Day 1 post-operatively (Mean oral equivalent elemental calcium of 7,090mg). Of the of 87 patients, 17 required >10,800mg oral equivalent calcium supplementation. Pre-operative variables; Alkaline Phosphatase (ALP); Parathyroid Hormone (PTH); and younger age (p <0.001; 0.04; and 0.04 respectively) were all statistically significant for predicting day 1 oral elemental calcium requirement >10,800mg. Binary logistic regression confirmed these pre-operative variables could exclude day 1 requirements >10,800mg in 95.7% of cases.

Conclusions:Pre-operative ALP, PTH and Age can be used to identify patients at lower risk of high post-operative calcium requirements following rPTX. Results can be used to inform changes to current LH protocols to admit all patients to HDU post PTX.

 


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