Perioperative hyperkalemia occurs frequently among patients on hemodialysis (HD) undergoing total parathyroidectomy (PTX) with autotransplantation, new study findings suggest.

The finding underscores the need for perioperative electrolyte surveillance and preoperative serum potassium control in these patients, according to investigators. For patients with high serum potassium at baseline and severe postoperative hypocalcemia and prolonged calcium supplementation, extended monitoring of serum potassium levels and changes in electrocardiogram readings is essential, they stated.

The study, which included 204 HD patients undergoing total PTX with autotransplantation for refractory secondary hyperparathyroidism, found a 66.7% rate of hyperkalemia during or immediately following surgery, a team from The First Affiliated Hospital of Nanjing Medical University in Jiangsu, China, led by Changying Xing, MD, reported in Internal and Emergency Medicine. In addition, 31.9% of patients suffered from pre-dialysis hyperkalemia 3 days after surgery.

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Immediately prior to surgery, no patient had hyperkalemia, which the investigators defined as a serum potassium level of 5.5 mmol/L or higher. Baseline potassium levels (the mean of 3 preoperative serum potassium values just before the start of an HD session) were the only independent factor influencing potassium levels after surgery, the investigators reported. More than a third (36.3%) of patients had baseline potassium levels of 5.5 mmol/L or higher.

Potential strategies for preventing preoperative hyperkalemia, such as avoidance of high-potassium foods and increasing dialysis frequency, are important in decreasing perioperative hyperkalemia risk to some extent, Dr Xing and colleagues stated.


Yang G, Wang J, Sun J, et al. Perioperative hyperkalemia in hemodialysis patients undergoing parathyroidectomy for renal hyperparathyroidism. Intern Emerg Med. 2019; published online ahead of print.