Role of Loading Calcitriol to Control Hypocalcemia after Parathyroidectomy in Chronic Kidney Disease
Sathit Niramitmahapanya MD*, Thongkum Sunthornthepvarakul MD*, Chaicharn Deerochanawong MD*, Veerasak Sarinnapakorn MD*, Pornake Athipan MD**
Affiliation : * Department of Internal Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand ** Department of Otolaryngology-head and Neck, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
Objective : To compare the effective calcitriol regimens in hypocalcimic hyperparathyroidism (HPT) patients who were
referred to parathyroidectomy.
Material and Method: Retrospective study of fifty patients who underwent parathyroidectomy in Rajavithi Hospital between
September 2001 and August 2009 was performed. The authors defined three regimens of calcitriol (A; fixed dose regimen,
B; titrated dose regimen and C; loading dose regimen) by reviewing 41 charts of patients with chronic kidney disease.
Biochemical factors available within two weeks before and after surgery were recorded and analyzed.
Results : Postoperative hypocalcemia was a common complication found in 82.93% (n = 34/41) of patients with chronic
kidney disease, 80.61% (n = 25/31) and 90% (n = 9/10) of secondary HPT and tertiary HPT, respectively. In multiple logistic
regression analysis; calcium-phosphorus product was the independent predictor of postoperative hypocalcemia requiring
intravenous calcium gluconate with statistical significance at p = 0.008, ROC analysis showed calcium phosphorus products
more than 53 mg2/dl2 represented the best compromise between sensitivity (0.71) and specificity (0.67) by area under the
curve = 0.755). The amount of intravenous calcium gluconate after parathyroidectomy in the loading calcitriol regimen
(initial dose 2.25-4 mcg/day) was significantly lower than that in the titrated calcitriol regimen (0.75-1.5 mcg/day) (p = 0.001).
Conclusion : Loading calcitriol regimen reduced hypocalcemic morbidity in postoperative parathyroidectomy in patients
with chronic kidney disease.
Keywords : Calcitriol, Parathyroidectomy, Chronic kidney disease
