{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T23:13:13Z","timestamp":1785453193194,"version":"3.56.0"},"reference-count":16,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,1,9]],"date-time":"2025-01-09T00:00:00Z","timestamp":1736380800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Parathyroidectomy (PTX) is generally curative in renal hyperparathyroidism (RHPT) that is refractory to medical treatment in end-stage kidney disease (ESKD) patients. Severe hypocalcemia is a common complication of PTX and results in increased monitoring, interventions, lengths of stay, and costs of care. This study aimed to find the determinants and cutoff values of the biochemical determinants, if any, for severe post-operative hypocalcemia after PTX in adult patients with ESKD. Methods: Severe post-operative hypocalcemia was defined as a lowest adjusted serum calcium level &lt; 2 mmol\/L during a hospitalization stay following PTX. Receiver operating curves (ROCs) with area under the curve (AUC) values for pre-operative intact parathyroid hormone (iPTH) and pre-operative alkaline phosphatase (ALP) levels against hypocalcemia were used to determine cutoffs. Generalized linear models using Poisson regression with robust error variance were used to estimate the relative risk of severe post-operative hypocalcemia. Results: In total, 75 patients (38 women, 50.7%) with a mean age of 53.8 \u00b1 11.4 years were enrolled; 43 (57%) patients developed severe hypocalcemia post-PTX and had higher pre-operative serum iPTH and ALP levels, as well as a significantly longer hospitalization post-operation (10.5 vs. 4.3 days, p =&lt; 0.001). A pre-operative iPTH level of &gt;166 pmol\/L had an AUC-ROC of 0.73 and 72% sensitivity and 73% specificity, respectively, in predicting severe post-operative hypocalcemia with a relative risk of 2.00 [95% CI 1.27\u20133.33, p = 0.003]. Conclusions: A pre-operative iPTH level &gt; 166 pmol\/L is a strong risk predictor for post-operative severe hypocalcemia. Pre-emptive interventions in this high-risk group could potentially result in a reduced length of stay and lower acuity of care.<\/jats:p>","DOI":"10.3390\/jcm14020379","type":"journal-article","created":{"date-parts":[[2025,1,9]],"date-time":"2025-01-09T07:00:47Z","timestamp":1736406047000},"page":"379","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Determinants of Severe Hypocalcemia After Parathyroidectomy in Patients with End-Stage Kidney Disease and Renal Hyperparathyroidism: A Retrospective Cohort Study"],"prefix":"10.3390","volume":"14","author":[{"given":"Zi Kheng","family":"Tan","sequence":"first","affiliation":[{"name":"Department of Renal Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 608433, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wan Limm","family":"Looi","sequence":"additional","affiliation":[{"name":"Department of Renal Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 608433, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fangxia","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Renal Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 608433, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0857-4781","authenticated-orcid":false,"given":"See Cheng","family":"Yeo","sequence":"additional","affiliation":[{"name":"Department of Renal Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 608433, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6124-9828","authenticated-orcid":false,"given":"Manohar","family":"Bairy","sequence":"additional","affiliation":[{"name":"Department of Renal Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 608433, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1050","DOI":"10.1080\/0886022X.2016.1184924","article-title":"Long-term mortality after parathyroidectomy among chronic kidney disease patients with secondary hyperparathyroidism: A systematic review and meta-analysis","volume":"38","author":"Chen","year":"2016","journal-title":"Ren. Fail."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1165","DOI":"10.4103\/1319-2442.121273","article-title":"Predictors of early post-operative hypocalcemia after parathyroidectomy for secondary hyperparathyroidism","volume":"24","author":"Hamouda","year":"2013","journal-title":"Saudi J. Kidney Dis. Transpl."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1177\/000313480407000204","article-title":"Post-parathyroidectomy hypocalcemia: Incidence, risk factors, and management","volume":"70","author":"Mittendorf","year":"2004","journal-title":"Am. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"98","DOI":"10.2215\/CJN.12941213","article-title":"Recent changes in therapeutic approaches and association with outcomes among patients with secondary hyperparathyroidism on chronic hemodialysis: The DOPPS study","volume":"10","author":"Tentori","year":"2015","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1080\/0886022X.2022.2048856","article-title":"Risk factors for hypocalcemia in dialysis patients with refractory secondary hyperparathyroidism after parathyroidectomy: A meta-analysis","volume":"44","author":"Gao","year":"2022","journal-title":"Ren. Fail."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Ho, L.Y., Wong, P.N., Sin, H.K., Wong, Y.-Y., Lo, K.-C., Chan, S.-F., Lo, M.-W., Lo, K.-Y., and Mak, S.-K. (2017). Risk factors and clinical course of hungry bone syndrome after total parathyroidectomy in dialysis patients with secondary hyperparathyroidism. BMC Nephrol., 18.","DOI":"10.1186\/s12882-016-0421-5"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1097\/MNH.0000000000000327","article-title":"Hungry bone syndrome","volume":"26","author":"Jain","year":"2017","journal-title":"Curr. Opin. Nephrol. Hypertens."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1007\/s11255-020-02387-0","article-title":"Hungry bone syndrome after parathyroidectomy in end-stage renal disease patients: Review of an alkaline phosphatase-based treatment protocol","volume":"52","author":"Wong","year":"2020","journal-title":"Int. Urol. Nephrol."},{"key":"ref_9","first-page":"1453","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for reporting observational studies","volume":"9596","author":"Altman","year":"2007","journal-title":"Lancet"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1443","DOI":"10.1007\/s11255-019-02217-y","article-title":"Bone metabolism markers and hungry bone syndrome after parathyroidectomy in dialysis patients with secondary hyperparathyroidism","volume":"51","author":"Ge","year":"2019","journal-title":"Int. Urol. Nephrol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1002\/bjs.6818","article-title":"Alkaline phosphatase predicts calcium requirements after total parathyroidectomy in patients receiving dialysis","volume":"97","author":"Goh","year":"2010","journal-title":"Br. J. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"183","DOI":"10.2147\/IJNRD.S56995","article-title":"Calcium supplementation after parathyroidectomy in dialysis and renal transplant patients","volume":"7","author":"Florescu","year":"2014","journal-title":"Int. J. Nephrol. Renovasc. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"8752826","DOI":"10.1155\/2022\/8752826","article-title":"Prediction Model of postoperative severe hypocalcemia in patients with secondary hyperparathyroidism based on logistic regression and XGBoost algorithm","volume":"2022","author":"Ding","year":"2022","journal-title":"Comput. Math. Methods Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1018","DOI":"10.1016\/j.surg.2005.09.018","article-title":"25-hydroxyvitamin D deficiency is a risk factor for symptoms of postoperative hypocalcemia and secondary hyperparathyroidism after minimally invasive parathyroidectomy","volume":"138","author":"Stewart","year":"2005","journal-title":"Surgery."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"R45","DOI":"10.1530\/EJE-12-0528","article-title":"Hungry bone syndrome: Still a challenge in the post-operative management of primary hyperparathyroidism: A systematic review of the literature","volume":"168","author":"Witteveen","year":"2013","journal-title":"Eur. J. Endocrinol."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"National Kidney Foundation (2003). K\/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am. J. Kidney Dis, 42, S1\u2013S201.","DOI":"10.1016\/S0272-6386(03)00905-3"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/2\/379\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T10:25:44Z","timestamp":1759919144000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/2\/379"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,9]]},"references-count":16,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,1]]}},"alternative-id":["jcm14020379"],"URL":"https:\/\/doi.org\/10.3390\/jcm14020379","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,9]]}}}