Hyperkalemia commonly occurs after parathyroidectomy (PTx) in patients on maintenance hemodialysis (HD), according to recent research. Now new study findings published in BMC Nephrology suggest pre-operative potassium levels may help predict it.

Of 90 HD patients who underwent total PTx by the same surgeon at Aerospace Center Hospital in Beijing, 22 developed immediate postoperative hyperkalemia (serum potassium level greater than 5.3 mmol/L) and 16 on day 3 (before dialysis). The mean serum potassium level was significantly higher in the postoperative group than the day 3 group: 4.94 vs 4.66 mmol/L. In a logistical univariate regression model, only preoperative serum potassium levels significantly predicted postoperative hyperkalemia, with levels above 3.9 mmol/L associated with a 59% increased odds of hyperkalemia development, Yu-Huan Song, MD, of the National Clinical Research Center for Kidney Diseases, and colleagues reported. In nonsignificant results, the condition appeared more likely to develop in male and younger PTx patients.

“Preoperative serum potassium concentrations should be controlled below 3.9 mmol/L to avoid postoperative hyperkalaemia,” Dr Song and his team wrote.

Whether total PTx in particular or surgery in general increases hyperkalemia risk in HD patients requires further research, including investigation of factors such as surgery duration and anesthesia, the team noted. Other research has linked preoperative cinacalcet use with hyperkalemia, but no patient in this cohort received the calcimimetic. The precise mechanisms underlying hyperkalemia following PTX remain unclear.

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Reference

Song YH, Cai GY, Xiao YF, et al. Can we predict who will develop postoperative hyperkalaemia after parathyroidectomy in dialysis patients with secondary hyperparathyroidism? BMC Nephrol. 20:225. doi:10.1186/s12882-019-1416-9