Cargando…

Hyperkalemia Following Parathyroidectomy in Patients with Renal Hyperparathyroidism—New Thresholds for Urgent Perioperative Dialysis

Parathyroidectomy (PTX) is a mainstay of treating secondary hyperparathyroidism (SHPT) in patients with kidney failure in order to reduce the incidence of cardiovascular events (CVE), increase overall survival and improve quality of life. Perioperative hyperkalemia may lead to devastating cardiac co...

Descripción completa

Detalles Bibliográficos
Autores principales: Bures, Claudia, Uluk, Yasmin, Besmens, Mona, Akca, Aycan, Dobrindt, Eva-Maria, Pratschke, Johann, Goretzki, Peter, Mogl, Martina, Uluk, Deniz
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8777922/
https://www.ncbi.nlm.nih.gov/pubmed/35054103
http://dx.doi.org/10.3390/jcm11020409
_version_ 1784637189918818304
author Bures, Claudia
Uluk, Yasmin
Besmens, Mona
Akca, Aycan
Dobrindt, Eva-Maria
Pratschke, Johann
Goretzki, Peter
Mogl, Martina
Uluk, Deniz
author_facet Bures, Claudia
Uluk, Yasmin
Besmens, Mona
Akca, Aycan
Dobrindt, Eva-Maria
Pratschke, Johann
Goretzki, Peter
Mogl, Martina
Uluk, Deniz
author_sort Bures, Claudia
collection PubMed
description Parathyroidectomy (PTX) is a mainstay of treating secondary hyperparathyroidism (SHPT) in patients with kidney failure in order to reduce the incidence of cardiovascular events (CVE), increase overall survival and improve quality of life. Perioperative hyperkalemia may lead to devastating cardiac complications. Distinct preoperative thresholds for serum potassium levels (SPL) were defined, but neither their usefulness nor consecutive risks are understood. This study compared the results and efficacy of different clinical procedures in preventing or treating perioperative hyperkalemia, including postoperative urgent hemodialysis (UHD). Methods: Patients from Charité-Universitätsmedizin Berlin and Rheinland Klinikum Lukaskrankenhaus, Neuss, undergoing PTX due to SHPT between 2008 and 2018 were analyzed retrospectively with regard to demographic parameters, surgery specific conditions and perioperative laboratory results. Comparisons of patient values from both centers with focus on perioperative hyperkalemia and the need for UHD were performed. Results: A total of 251 patients undergoing PTX for SHPT were included (Neuss: n = 121 (48%); Berlin: n = 130 (52%)). Perioperative hyperkalemia (SPL ≥ 5.5 mmol/L) was noted in 134 patients (53%). UHD on the day of surgery was performed especially in patients with intraoperative hyperkalemia, in females (n = 40 (16%) vs. n = 27 (11%); p = 0.023), in obese patients (n = 27 (40%) vs. n = 50 (28%), p = 0.040) and more often in patients treated in Neuss (n = 42 (35%) vs. 25 (19%); p = 0.006). For patients treated in Neuss, the intraoperative hyperkalemia cut-off level above 5.75 mmol/L was the most predictive factor for UHD (n = 30 (71%) vs. n = 8 (10%); p < 0.001). Concerning secondary effects of hyperkalemia or UHD, no patient died within the postoperative period, and only three patients suffered from acute CVE, with SPL > 5.5 mmol/L measured in only one patient. Conclusion: Perioperative values could not predict postoperative hyperkalemia with the need for UHD. Previously defined cut-off levels for SPL should be reconsidered, especially for patients undergoing PTX. Early postoperative dialysis in patients with postoperative hyperkalemia can be performed with a low risk for complications and may be indicated for all patients with increased perioperative SPL.
format Online
Article
Text
id pubmed-8777922
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-87779222022-01-22 Hyperkalemia Following Parathyroidectomy in Patients with Renal Hyperparathyroidism—New Thresholds for Urgent Perioperative Dialysis Bures, Claudia Uluk, Yasmin Besmens, Mona Akca, Aycan Dobrindt, Eva-Maria Pratschke, Johann Goretzki, Peter Mogl, Martina Uluk, Deniz J Clin Med Article Parathyroidectomy (PTX) is a mainstay of treating secondary hyperparathyroidism (SHPT) in patients with kidney failure in order to reduce the incidence of cardiovascular events (CVE), increase overall survival and improve quality of life. Perioperative hyperkalemia may lead to devastating cardiac complications. Distinct preoperative thresholds for serum potassium levels (SPL) were defined, but neither their usefulness nor consecutive risks are understood. This study compared the results and efficacy of different clinical procedures in preventing or treating perioperative hyperkalemia, including postoperative urgent hemodialysis (UHD). Methods: Patients from Charité-Universitätsmedizin Berlin and Rheinland Klinikum Lukaskrankenhaus, Neuss, undergoing PTX due to SHPT between 2008 and 2018 were analyzed retrospectively with regard to demographic parameters, surgery specific conditions and perioperative laboratory results. Comparisons of patient values from both centers with focus on perioperative hyperkalemia and the need for UHD were performed. Results: A total of 251 patients undergoing PTX for SHPT were included (Neuss: n = 121 (48%); Berlin: n = 130 (52%)). Perioperative hyperkalemia (SPL ≥ 5.5 mmol/L) was noted in 134 patients (53%). UHD on the day of surgery was performed especially in patients with intraoperative hyperkalemia, in females (n = 40 (16%) vs. n = 27 (11%); p = 0.023), in obese patients (n = 27 (40%) vs. n = 50 (28%), p = 0.040) and more often in patients treated in Neuss (n = 42 (35%) vs. 25 (19%); p = 0.006). For patients treated in Neuss, the intraoperative hyperkalemia cut-off level above 5.75 mmol/L was the most predictive factor for UHD (n = 30 (71%) vs. n = 8 (10%); p < 0.001). Concerning secondary effects of hyperkalemia or UHD, no patient died within the postoperative period, and only three patients suffered from acute CVE, with SPL > 5.5 mmol/L measured in only one patient. Conclusion: Perioperative values could not predict postoperative hyperkalemia with the need for UHD. Previously defined cut-off levels for SPL should be reconsidered, especially for patients undergoing PTX. Early postoperative dialysis in patients with postoperative hyperkalemia can be performed with a low risk for complications and may be indicated for all patients with increased perioperative SPL. MDPI 2022-01-14 /pmc/articles/PMC8777922/ /pubmed/35054103 http://dx.doi.org/10.3390/jcm11020409 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Bures, Claudia
Uluk, Yasmin
Besmens, Mona
Akca, Aycan
Dobrindt, Eva-Maria
Pratschke, Johann
Goretzki, Peter
Mogl, Martina
Uluk, Deniz
Hyperkalemia Following Parathyroidectomy in Patients with Renal Hyperparathyroidism—New Thresholds for Urgent Perioperative Dialysis
title Hyperkalemia Following Parathyroidectomy in Patients with Renal Hyperparathyroidism—New Thresholds for Urgent Perioperative Dialysis
title_full Hyperkalemia Following Parathyroidectomy in Patients with Renal Hyperparathyroidism—New Thresholds for Urgent Perioperative Dialysis
title_fullStr Hyperkalemia Following Parathyroidectomy in Patients with Renal Hyperparathyroidism—New Thresholds for Urgent Perioperative Dialysis
title_full_unstemmed Hyperkalemia Following Parathyroidectomy in Patients with Renal Hyperparathyroidism—New Thresholds for Urgent Perioperative Dialysis
title_short Hyperkalemia Following Parathyroidectomy in Patients with Renal Hyperparathyroidism—New Thresholds for Urgent Perioperative Dialysis
title_sort hyperkalemia following parathyroidectomy in patients with renal hyperparathyroidism—new thresholds for urgent perioperative dialysis
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8777922/
https://www.ncbi.nlm.nih.gov/pubmed/35054103
http://dx.doi.org/10.3390/jcm11020409
work_keys_str_mv AT buresclaudia hyperkalemiafollowingparathyroidectomyinpatientswithrenalhyperparathyroidismnewthresholdsforurgentperioperativedialysis
AT ulukyasmin hyperkalemiafollowingparathyroidectomyinpatientswithrenalhyperparathyroidismnewthresholdsforurgentperioperativedialysis
AT besmensmona hyperkalemiafollowingparathyroidectomyinpatientswithrenalhyperparathyroidismnewthresholdsforurgentperioperativedialysis
AT akcaaycan hyperkalemiafollowingparathyroidectomyinpatientswithrenalhyperparathyroidismnewthresholdsforurgentperioperativedialysis
AT dobrindtevamaria hyperkalemiafollowingparathyroidectomyinpatientswithrenalhyperparathyroidismnewthresholdsforurgentperioperativedialysis
AT pratschkejohann hyperkalemiafollowingparathyroidectomyinpatientswithrenalhyperparathyroidismnewthresholdsforurgentperioperativedialysis
AT goretzkipeter hyperkalemiafollowingparathyroidectomyinpatientswithrenalhyperparathyroidismnewthresholdsforurgentperioperativedialysis
AT moglmartina hyperkalemiafollowingparathyroidectomyinpatientswithrenalhyperparathyroidismnewthresholdsforurgentperioperativedialysis
AT ulukdeniz hyperkalemiafollowingparathyroidectomyinpatientswithrenalhyperparathyroidismnewthresholdsforurgentperioperativedialysis