Low preoperative serum calcium levels increase the likelihood of hypocalcemia after parathyroidectomy (PTx) in patients with secondary hyperparathyroidism (SHPT), according to results of a new meta-analysis.

Investigators performed a meta-analysis of 13 “high-quality” studies published from 2013 to 2021 involving 1739 patients who underwent total PTx or subtotal PTX (with or without autotransplantation) or ultrasound-guided microwave ablation (MWA) and 1251 patients who had none of these procedures.

Preoperative hypocalcemia was significantly associated with 81% increased odds for postoperative hypocalcemia, Guangdong Sun, MD, PhD, of The Second Hospital of Jilin University, China, and colleagues reported in Renal Failure. “The results of this study strongly suggest that appropriate calcium supplement therapy should be provided in patients with hypocalcemia before PTX to alleviate the postoperative complications of hypocalcemia,” they wrote.

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Lower preoperative alkaline phosphatase (ALP) and intact parathyroid hormone (iPTH) levels were significantly associated with 1% and 38% decreased odds for postoperative hypocalcemia, respectively. The investigators believe that, conversely, high preoperative ALP and iPTH levels are risk factors for postoperative hypocalcemia.

Hypocalcemia can cause weakness, headache, paresthesia, muscle cramps, laryngeal stridor, seizures, cardiac arrhythmias, and tetany.

According to Dr Sun’s team, “Some examples of targeted [perioperative] intervention measures include early withdrawal of calcimimetics before surgery, monitoring of blood calcium level at intervals of 6 h after surgery, and early placement of intravenous access for high-dose calcium supplementation.”


Gao D, Lou Y, Cui Y, Liu S, Cui W, Sun G. Risk factors for hypocalcemia in dialysis patients with refractory secondary hyperparathyroidism after parathyroidectomy: a meta-analysis. Ren Fail. 44(1):503-512. doi:10.1080/0886022X.2022.2048856