Pre-operative Cinacalcet Administration Reduces Immediate Post-operative Hypocalcemia Following Total Parathyroidectomy in Severe Renal Hyperparathyroidism

• Published in: World journal of surgery Vol. 47; no. 8; pp. 1986 - 1994
• Main Authors: Fung, Matrix Man-Him, Tam, Dick-Sang, Lui, David Tak-Wai, Lang, Brian Hung-Hin
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.08.2023; Springer Nature B.V
• Subjects: Abdominal Surgery; Calcium; Cardiac Surgery; Cinacalcet - therapeutic use; Correlation; Dietary supplements; General Surgery; Humans; Hypercalcemia; Hyperparathyroidism; Hyperparathyroidism - surgery; Hyperparathyroidism, Secondary - drug therapy; Hyperparathyroidism, Secondary - surgery; Hypocalcemia; Hypocalcemia - etiology; Hypocalcemia - prevention & control; Medicine; Medicine & Public Health; Original Scientific Report; Parathyroid Hormone; Parathyroidectomy; Retrospective Studies; Serum albumin; Surgery; Thoracic Surgery; Treatment Outcome; Vascular Surgery; Vitamin D
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-023-07030-4

Background In severe renal hyperparathyroidism (RHPT), whether administrating Cinacalcet before total parathyroidectomy can reduce post-operative hypocalcemia remains unclear. We compared post-operative calcium kinetics between those who took Cinacalcet before surgery (Group I) and those who did not (Group II). Methods Patients with severe RHPT (defined by PTH ≥ 100 pmol/L) who underwent total parathyroidectomy between 2012 and 2022 were analyzed. Standardized peri-operative protocol of calcium and vitamin D supplementation was followed. Blood tests were performed twice daily in the immediate post-operative period. Severe hypocalcemia was defined as serum albumin-adjusted calcium < 2.00 mmol/L. Results Among 159 patients who underwent parathyroidectomy, 82 patients were eligible for analysis (Group I, n  = 27; Group II, n  = 55). Demographics and PTH levels before Cinacalcet administration were comparable (Group I: 169 ± 49 pmol/L vs Group II: 154 ± 45, p  = 0.209). Group I had significantly lower pre-operative PTH (77 ± 60 pmol/L vs 154 ± 45, p  < 0.001), higher post-operative calcium ( p  < 0.05), and lower rate of severe hypocalcemia (33.3% vs 60.0%, p  = 0.023). Longer duration of Cinacalcet use correlated with higher post-operative calcium levels ( p  < 0.05). Cinacalcet use for > 1 year resulted in fewer severe post-operative hypocalcemia than non-users ( p  = 0.022, OR 0.242, 95% CI 0.068–0.859). Higher pre-operative ALP independently correlated with severe post-operative hypocalcemia (OR 3.01, 95% CI 1.17–7.77, p  = 0.022). Conclusion In severe RHPT, Cinacalcet led to significant drop in pre-operative PTH, higher post-operative calcium levels, and less frequent severe hypocalcemia. Longer duration of Cinacalcet use correlated with higher post-operative calcium levels, and the use of Cinacalcet for > 1 year reduced severe post-operative hypocalcemia.