P93
HYPOCALCAEMIA MANAGEMENT POST PARATHYROIDECTOMY IN RENAL
PATIENTS-A SINGLE CENTRE REVIEW
Rajkumar Chinnadurai1, Constantina Chrysochou1, Helen Doran2, Smeeta Sinha1
1
Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, 2Department of
Endocrine Surgery, Salford Royal NHS Foundation Trust, Salford
Introduction
Hypocalcaemia is common post parathyroidectomy in renal patients with secondary
hyperparathyroidism due to hungry bone syndrome with an incidence as high as 51%1.Hypocalcemia
can be prevented by effectively preloading patient with Vitamin D supplements and monitoring
calcium levels post operatively. Ourhospitalhas guidelines for the management of renal patients post
parathyroidectomy which specifies that all patients are preloaded with 2 mcg one-alphacalcidol for 5
days pre operatively.
Objective
To study the management of hypocalcemia post parathyroidectomy in renal patients and how this
influenced length of patient hospital stay. To identify if any changes in current guideline could
improve outcome.
Methods
List of all renal patients who underwent a parathyroidectomy under a single surgeon between April
2008 to September 2014 was gathered.Data on demographics, modality, preloading, post-operative
calcium management and length of hospital stay (LOS) were collected from the Electronic Patient
Record. Data were analysed using Excel.
Results
72% of our sample (n = 25) were male with a mean age of 54.Of the 25 there were 13 transplant, 9
hemodialysis and 3 CKD patients. The mean hospital stay was 5 daysshorter than quoted in the
literature (5.6 Days) 2. 3 of 25 patients werenot preloaded.40% of our patients needed intravenous
calcium replacements. Hemodialysis patients had longer LOS than CKD and Transplant patients, this
group were more likely to not have received pre-loading. Those undergoing a total parathyroidectomy
hadincreased LOS compared to subtotal parathyroidectomy. There were no surgical complications
contributing to a delay in discharge.
Conclusions and Outcome
Insufficient preloading was identified as a major risk factor for hypocalcemia and increased LOS.
Further to consensus between the surgical andrenal multi-disciplinaryteam, it was decided to increase
the preloading dose of one-alphacalcidol to 5 mcg for 5 days pre operatively.More attention to
adhering to pre-loading guidelines across the different dialysis units was reinforced. A repeat review
is planned in 6 months after this change.
References
1. Incidence of and risk factors for hungry bone syndrome in 84 patients with secondary
hyperparathyroidism. JoergLatus et Al, International Journal of Nephrology and Reno
vascular Disease, July 20132.
2. Prolonged Hospital Stay after Parathyroidectomy for Secondary Hyperparathyroidism,
Shih-Ping Cheng et Al World Journal of Surgery January 2009, Volume 33, Issue 1, pp 72-79