Background: Patients of secondary hyperparathyroidism (SHPT) with chronic renal failure treated by long-term dialysis have received surgical treatment. The severe complications, especially severe hypocalcemia, would endanger lives during perioperative treatment. Therefore, this study aims to recommend a simple, sustained and sufficient perioperative calcium regulation scheme, and analysis of preoperative related indicators, the patient's condition for a preliminary assessment, thus guiding the postoperative calcium regulation, to avoid the occurrence of serious complications.
Methods: We reviewed the clinical data of 136 patients with chronic renal failure in uremic stage, who received dialysis treatment for a long time and finally diagnosed as SHPT, from Jan 2017 to Dec 2019, were accepted different operations to treat hyperparathyroidism, were given corresponding calcium regulation therapy to avoid serious complications, and were divided into the observation group and the control group according to the mean time of postoperative calcium regulation time.
Results: According to the median time of adjusting the pump calcium(7.67 + 2.823)d, the patients were divided into two groups: the observation group (≤7d) and the control group (> 7d). 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 SHPT, and be able to avoid the occurrence of severe hypocalcemia and increase the curate. Especially for the younger, the lower preoperative serum calcium, the higher blood PTH and ALP, should lengthen the calcium pump time appropriately, until the right time and stop the medicine. This is more safe.