Background: Patients of secondary hyperparathyroidism (SHPT) with chronic renal failure treated by long-term dialysis have received surgical treatment. The severe complications, especially convulsions caused by severe hypocalcemia, would endanger lives during perioperative treatment. Therefore, this study aims to explore a simple, sustained and sufficient calcium regulation scheme during perioperative period, which could stabilize blood calcium concentration and correct calcium deficiency, greatly reduce the occurrence of the complications.
Methods: We reviewed the clinical data of 136 patients with chronic renal failure in uremic stage from Jinzhou Central Hospital and the Second Affiliated Hospital of Dalian Medical University, who received dialysis treatment for a long time and finally diagnosed as secondary hyperparathyroidism, from Jan 2017 to Dec 2019, were accepted different operations to treat hyperparathyroidism, were given corresponding calcium regulation therapy to avoid serious complications were, and were divided into the observation group and the control group according to the postoperative calcium regulation time of ≤7 days and > 7 days, which is defined by the mean time of postoperative calcium regulation, and by the time from the day of operation until the day when the patients have stable blood calcium levels and no obvious discomfort symptoms.
Results: Compared with the control group, the observation group were elder (54.01±9.215, P<0.01), shorter preoperative dialysis time (5.05±2.855, P<0.01), significant difference in operation mode (P=0.026), positive preoperative oral calcium(c2=9.941, P=0.002), higher preoperative calcium value (t=4.795, P<0.001), lower preoperative Parathyroid Hormone(PTH) value (t=6.327, P<0.001), lower preoperative Alkaline phosphatase (ALP) value (t=3.527, P=0.001). Multivariate analysis showed that age, preoperative calcium value, preoperative PTH value and preoperative ALP value were independent risk factors for postoperative calcium regulation therapy. Those factors, Gender, preoperative dialysis mode, complications, preoperative Hemoglobin(HB) value, were not related to postoperative calcium regulation. There was no significant difference between the two groups (P>0.05).
Conclusion: The simple, sustained and sufficient calcium regulation scheme can maintain a stable level of blood calcium in the dialytic CKD patients with secondary hyperparathyroidism, so as to avoid the occurrence of severe hypocalcemia and increase the curate.