[Parathyroidectomy in end-stage renal disease: perioperative management of calcium-phosphorus balance]

The management of metabolic problems following parathyroidectomy in end stage renal disease remains poorly defined. Hypocalcemia is a common and serious complication in the post-operative period. The objective of the present study was to develop a protocol for the management of patients during the immediate perioperative period based on the best available data from the literature, and to verify its effectiveness and safety in three patients on chronic hemodialysis. A patient management protocol was developed based on data reported in the literature and was subsequently tested on three chronic dialysis patients suffering from tertiary hyperparathyroidism with an indication of parathyroidectomy. According to the literature, the risk of hypocalcemia following parathyroidectomy can be decreased by tight surveillance of calcium levels and preventive administration of calcium and vitamin D analogue to patients at high risk of hypocalcemia. By applying this protocol, profound hypocalcemia was avoided and the immediate post-operative period was uneventful in the three patients under study. In summary, the proposed protocol is safe and effective for the peri-parathyroidectomy management of patients on chronic hemodialysis.