Abstract: TH-PO0217
Effect of Intravenous Calcium on Perioperative Hyperkalemia Risk After Parathyroidectomy in Patients on Dialysis with Secondary Hyperparathyroidism
Session Information
- Bone and Mineral Metabolism: Clinical Reports and Practice
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Bone and Mineral Metabolism
- 502 Bone and Mineral Metabolism: Clinical
Authors
- Arroyo, Jimena, Universidad Nacional Autonoma de Mexico, Mexico City, CDMX, Mexico
- Calderón, Abril Jacqueline, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, CDMX, Mexico
- Cojuc, Gabriel, Harvard Medical School, Boston, Massachusetts, United States
- Zavala Miranda, Fernanda, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, CDMX, Mexico
- Delgado Avila, Brenda Guadalupe, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, CDMX, Mexico
- Velazquez-Fernandez, David, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, CDMX, Mexico
- Ramirez-Sandoval, Juan Carlos, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, CDMX, Mexico
Background
Postoperative hyperkalemia is a known complication following parathyroidectomy for secondary hyperparathyroidism. One hypothesis proposes that a rapid decline in extracellular Ca increases Na influx into skeletal muscle via the Na-Ca exchanger, counteracting K flux mediated by Na/K ATPase. We aimed to evaluate whether an intravenous Ca infusion administered immediately after parathyroidectomy was associated with changes in postoperative potassium levels.
Methods
We implemented an institutional protocol to prevent complications related to severe hypocalcemia in dialysis patients with secondary hyperparathyroidism undergoing parathyroidectomy. The protocol includes initiating a continuous intravenous (IV) Ca infusion at a rate of 24 mg/h immediately after gland removal in high-risk patients (alkaline phosphatase >250 IU/L). The infusion was maintained for 24 hours. We compared changes in potassium levels before (n=87, 2003–2019) and after (n=60, 2021–2025) implementation of the IV Ca infusion protocol.
Results
Potassium levels measured 6–11 hours immediately following gland removal decreased in patients who received IV Ca (−0.42 ± 0.79 mEq/L, P<0.001) and increased in those who did not (+0.40 ± 1.09 mEq/L, P<0.001); intergroup difference −0.83 mEq/L, P<0.001. The frequency of postoperative hyperkalemia ≥5.5 mEq/L (25% vs. 47%, P=0.02, OR 0.39 95% CI 0.19-0.81), hyperkalemia ≥6.5 mEq/L (3% vs. 14%, P=0.02, OR 0.11 95% CI 0.01-0.84), and the need for emergency hemodialysis (3% vs. 18%, P=0.01, OR 0.081 95% CI 0.01-0.63) were significantly lower in the IV Ca group compared to the non-IV Ca group.
Conclusion
Early perioperative IV Ca to prevent hypocalcemia after parathyroidectomy may reduce the risk of hyperkalemia and the need for urgent hemodialysis.