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Article: Pre-operative Cinacalcet Administration Reduces Immediate Post-operative Hypocalcemia Following Total Parathyroidectomy in Severe Renal Hyperparathyroidism
Title | Pre-operative Cinacalcet Administration Reduces Immediate Post-operative Hypocalcemia Following Total Parathyroidectomy in Severe Renal Hyperparathyroidism |
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Authors | |
Issue Date | 4-May-2023 |
Publisher | Springer |
Citation | World Journal of Surgery, 2023 How to Cite? |
Abstract | BackgroundIn severe renal hyperparathyroidism (RHPT), whether administrating Cinacalcet before total parathyroidectomy can reduce post-operative hypocalcemia remains unclear. We compared post-operative calcium kinetics between those who took Cinacalcet before surgery (Group I) and those who did not (Group II). MethodsPatients with severe RHPT (defined by PTH ≥ 100 pmol/L) who underwent total parathyroidectomy between 2012 and 2022 were analyzed. Standardized peri-operative protocol of calcium and vitamin D supplementation was followed. Blood tests were performed twice daily in the immediate post-operative period. Severe hypocalcemia was defined as serum albumin-adjusted calcium < 2.00 mmol/L. ResultsAmong 159 patients who underwent parathyroidectomy, 82 patients were eligible for analysis (Group I, n = 27; Group II, n = 55). Demographics and PTH levels before Cinacalcet administration were comparable (Group I: 169 ± 49 pmol/L vs Group II: 154 ± 45, p = 0.209). Group I had significantly lower pre-operative PTH (77 ± 60 pmol/L vs 154 ± 45, p < 0.001), higher post-operative calcium (p < 0.05), and lower rate of severe hypocalcemia (33.3% vs 60.0%, p = 0.023). Longer duration of Cinacalcet use correlated with higher post-operative calcium levels (p < 0.05). Cinacalcet use for > 1 year resulted in fewer severe post-operative hypocalcemia than non-users (p = 0.022, OR 0.242, 95% CI 0.068–0.859). Higher pre-operative ALP independently correlated with severe post-operative hypocalcemia (OR 3.01, 95% CI 1.17–7.77, p = 0.022). ConclusionIn severe RHPT, Cinacalcet led to significant drop in pre-operative PTH, higher post-operative calcium levels, and less frequent severe hypocalcemia. Longer duration of Cinacalcet use correlated with higher post-operative calcium levels, and the use of Cinacalcet for > 1 year reduced severe post-operative hypocalcemia. |
Persistent Identifier | http://hdl.handle.net/10722/328464 |
ISSN | 2023 Impact Factor: 2.3 2023 SCImago Journal Rankings: 0.772 |
DC Field | Value | Language |
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dc.contributor.author | Fung, Matrix Man-Him | - |
dc.contributor.author | Tam, Dick-Sang | - |
dc.contributor.author | Lui, David Tak-Wai | - |
dc.contributor.author | Lang, Brian Hung-Hin | - |
dc.date.accessioned | 2023-06-28T04:45:11Z | - |
dc.date.available | 2023-06-28T04:45:11Z | - |
dc.date.issued | 2023-05-04 | - |
dc.identifier.citation | World Journal of Surgery, 2023 | - |
dc.identifier.issn | 0364-2313 | - |
dc.identifier.uri | http://hdl.handle.net/10722/328464 | - |
dc.description.abstract | <h3>Background</h3><p>In severe renal hyperparathyroidism (RHPT), whether administrating Cinacalcet before total parathyroidectomy can reduce post-operative hypocalcemia remains unclear. We compared post-operative calcium kinetics between those who took Cinacalcet before surgery (Group I) and those who did not (Group II).</p><h3>Methods</h3><p>Patients with severe RHPT (defined by PTH ≥ 100 pmol/L) who underwent total parathyroidectomy between 2012 and 2022 were analyzed. Standardized peri-operative protocol of calcium and vitamin D supplementation was followed. Blood tests were performed twice daily in the immediate post-operative period. Severe hypocalcemia was defined as serum albumin-adjusted calcium < 2.00 mmol/L.</p><h3>Results</h3><p>Among 159 patients who underwent parathyroidectomy, 82 patients were eligible for analysis (Group I, <em>n</em> = 27; Group II, <em>n</em> = 55). Demographics and PTH levels before Cinacalcet administration were comparable (Group I: 169 ± 49 pmol/L vs Group II: 154 ± 45, <em>p</em> = 0.209). Group I had significantly lower pre-operative PTH (77 ± 60 pmol/L vs 154 ± 45, <em>p</em> < 0.001), higher post-operative calcium (<em>p</em> < 0.05), and lower rate of severe hypocalcemia (33.3% vs 60.0%, <em>p</em> = 0.023). Longer duration of Cinacalcet use correlated with higher post-operative calcium levels (<em>p</em> < 0.05). Cinacalcet use for > 1 year resulted in fewer severe post-operative hypocalcemia than non-users (<em>p</em> = 0.022, OR 0.242, 95% CI 0.068–0.859). Higher pre-operative ALP independently correlated with severe post-operative hypocalcemia (OR 3.01, 95% CI 1.17–7.77, <em>p</em> = 0.022).</p><h3>Conclusion</h3><p>In severe RHPT, Cinacalcet led to significant drop in pre-operative PTH, higher post-operative calcium levels, and less frequent severe hypocalcemia. Longer duration of Cinacalcet use correlated with higher post-operative calcium levels, and the use of Cinacalcet for > 1 year reduced severe post-operative hypocalcemia.<br></p> | - |
dc.language | eng | - |
dc.publisher | Springer | - |
dc.relation.ispartof | World Journal of Surgery | - |
dc.title | Pre-operative Cinacalcet Administration Reduces Immediate Post-operative Hypocalcemia Following Total Parathyroidectomy in Severe Renal Hyperparathyroidism | - |
dc.type | Article | - |
dc.identifier.doi | 10.1007/s00268-023-07030-4 | - |
dc.identifier.eissn | 1432-2323 | - |
dc.identifier.issnl | 0364-2313 | - |