Perioperative hyperkalemia may warrant urgent hemodialysis (HD) in patients undergoing parathyroidectomy (PTx) for secondary hyperparathyroidism, according to investigators.

Among 251 patients undergoing PTx at 2 German centers, 134 (53%) experienced perioperative hyperkalemia with serum potassium levels of 5.5 mmol/L or higher. Intraoperative serum potassium levels above this threshold were significantly associated with 6-fold increased odds for urgent same-day HD, corresponding author Deniz Uluk, MD, of Charité-Universitätsmedizin Berlin, Berlin, Germany, and colleagues reported in the Journal of Clinical Medicine.

Urgent dialysis for hyperkalemia was performed significantly more often at the Neuss center (35% vs 19% in Berlin), especially when intraoperative serum potassium levels exceeded 5.75 mmol/L (71% vs 10% below that threshold). Urgent dialysis was also significantly more common among women than men (16% vs 11%) and obese than normal-weight individuals (40% vs 28%).

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Dr Uluk’s team found that intraoperative hyperkalemia strongly correlated with low serum calcium levels. Intraoperative hyperkalemia was significantly associated with the lowest serum calcium values (1.76 vs 1.86 mmol/L) and perioperative calcium decrease (26% vs 20%). A decrease in serum calcium levels after PTx was significantly associated with 5- and 4-fold increased odds for intraoperative hyperkalemia and urgent dialysis, respectively, the investigators reported.

With respect to adverse effects, 3 patients had a cardiovascular event including 1 patient with a serum potassium level exceeding 5.5 mmol/L, but no patient died.

“Physicians should aim for normal serum calcium levels, prevent the incidence of hungry bone syndrome and perform strict inspections of serum potassium levels perioperatively,” Dr Uluk’s team wrote. “Enforced dialysis on the day of parathyroidectomy is recommended—rather early and preventatively before complications occur.”


Bures C, Uluk Y, Besmens M, et al. Hyperkalemia following parathyroidectomy in patients with renal hyperparathyroidism — new thresholds for urgent perioperative dialysis. J Clin Med. 2022 Jan 14;11(2):409. doi:10.3390/jcm11020409