Abstract: TH-PO0219
Outcomes of a Hypocalcemia Prevention Strategy Following Parathyroidectomy for Severe Hyperparathyroidism: A Single-Center Study in Mexico
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
- Delgado Avila, Brenda Guadalupe, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, CDMX, Mexico
- Castro Almanza, Carlos Antonio, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, CDMX, Mexico
- Cojuc, Gabriel, Harvard Medical School, Boston, Massachusetts, United States
- Calderón, Abril Jacqueline, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, CDMX, Mexico
- Canaviri, Vianca Anabel, Hospital Obrero No 1, La Paz, La Paz Department, Bolivia, Plurinational State of
- Zavala Miranda, Fernanda, 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
Severe hypocalcemia is a common complication in patients with end stage kidney disease (ESKD) and severe hyperparathyroidism undergoing parathyroidectomy. Effective perioperative strategies are needed to reduce its incidence and associated morbidity. This study evaluated the effectiveness of a treatment protocol for the prevention of severe hypocalcemia following parathyroidectomy.
Methods
We implemented an institutional protocol to prevent complications related to severe hypocalcemia in dialysis patients with secondary hyperparathyroidism undergoing parathyroidectomy. The protocol included initiating a continuous intravenous (IV) calcium infusion at a rate of 24 mg/h immediately after gland removal in high-risk patients (defined as those with alkaline phosphatase >250 IU/L). The infusion was maintained for 24 hours. We compared the occurrence of severe hypocalcemia (free calcium <3.2 mg/dL) before (2003–2019) and after (2021–2025) the implementation of the IV calcium infusion protocol. Due to the historically high rate of complications, a concurrent control group was not included for ethical reasons.
Results
The intervention was administered to 73 patients (57% female; mean age 38 ± 10 years; preoperative iPTH 2359 [IQR 1358–3101] pg/mL) and compared with a historical cohort of 79 patients (47% female; mean age 37 ± 13 years; preoperative iPTH 1917 [IQR 1194–2772] pg/mL). Under the new protocol, a significantly lower proportion of patients developed severe hypocalcemia during hospitalization (5% vs. 77%; RR 0.09 [95% CI 0.02–0.35] per patient-day; p < 0.001). Median length of hospital stay was also significantly lower in the intervention group compared to the historical cohort (4 [IQR 2–6] vs. 5 [IQR 4–7] days; p= 0.04). No significant difference was observed in the proportion of patients with severe hypercalcemia (free calcium >6.9 mg/dL) (11% vs. 4%; RR 2.9 [95% CI 0.6–14.0] per patient-day; p= 0.19).
Conclusion
Early perioperative IV calcium, as part of the new protocol, was associated with a markedly reduced risk of severe hypocalcemia and shorter hospital stays in ESKD patients undergoing parathyroidectomy.