Role of loading calcitriol to control hypocalcemia after parathyroidectomy in chronic kidney disease

To compare the effective calcitriol regimens in hypocalcimic hyperparathyroidism (HPT) patients who were referred to parathyroidectomy.

Retrospective study of fifty patients who underwent parathyroidectomy in Rajavithi Hospital between September 2001 and August 2009 was performed. The authors defined three regimens of calcitriol (A; fixed dose regimen, B; titrated dose regimen and C; loading dose regimen) by reviewing 41 charts of patients with chronic kidney disease. Biochemical factors available within two weeks before and after surgery were recorded and analyzed.

Postoperative hypocalcemia was a common complication found in 82.93% (n = 34/41) of patients with chronic kidney disease, 80.61% (n = 25/31) and 90% (n = 9/10) of secondary HPT and tertiary HPT, respectively. In multiple logistic regression analysis; calcium-phosphorus product was the independent predictor of postoperative hypocalcemia requiring intravenous calcium gluconate with statistical significance atp = 0.008, ROC analysis showed calcium phosphorus products more than 53 mg2/dl2 represented the best compromise between sensitivity (0.71) and specificity (0.67) by area under the curve = 0.755). The amount of intravenous calcium gluconate after parathyroidectomy in the loading calcitriol regimen (initial dose 2.25-4 mcg/day) was significantly lower than that in the titrated calcitriol regimen (0.75-1.5 mcg/day) (p = 0.001).

Loading calcitriol regimen reduced hypocalcemic morbidity in postoperative parathyroidectomy in patients with chronic kidney disease.