![]() Ca-free P-binders with dietary P restriction appear to lower fibroblast growth factor-23 and improve cardiovascular and renal outcomes in patients with SHPT. At high doses, Ca-based P-binders may elevate the risk of vascular calcification. ![]() In ESRD, medical treatment for secondary hyperparathyroidism has three main strategies: reduction of P uptake by dialysis, dietary restriction, and/or P-binders calcimimetics and vitamin D.ĭue to toxicity, aluminum-based P-binders have been replaced by those containing Ca salts. SHPT is a serious manifestation of chronic kidney disease (CKD) with negative effects on patients’ life quality and outcome. In patients with end-stage renal disease (ESRD), parathyroid hyperplasia, high circulation parathyroid hormone (PTH), and hyperphosphatemia characterize secondary hyperparathyroidism (SHPT). The readmission rate (0.62%) due to hypocalcemia was rare. The post-operative hospitalization in Group B was 3–5 days shorter than that previously reported. Serum Ca levels <7.6 mg/dL at 18 h post-operation were the optimal cutoff value for hypocalcemia that needed i.v. Young age, low Ca, and high Alk-ptase levels and long operation time were independent risk factors for severe hypocalcemia. ![]() Ca gluconate 8 g/150 dL (5% glucose)/day was administered for Ca levels <6.5 mg/dL, 4–6 g/75 dL/day for levels <7.6 mg/dL, and 2 g/15 dL/15 min for symptomatic hypocalcemia. These serum levels were checked again 18 h post-operatively. Preoperatively, patient age was recorded, and serum Ca, P, alkaline phosphatase (Alk-ptase), and intact parathyroid hormone (iPTH) levels were checked. Group B (75 patients) who had post-operative serum Ca levels 4 g of intravenous (i.v.) Ca gluconate to keep Ca levels ≥6.5 mg/dL developed severe hypocalcemia. Group A (247 patients) developed mild hypocalcemia. Totally, 322 patients who were successfully treated with total parathyroidectomy and bilateral thymectomy plus autotransplantation were studied. Severe hypocalcemia is a serious complication occurring after parathyroidectomy for secondary hyperparathyroidism.
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