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

Abstract

AbstractBackgroundIn 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).MethodsPatients 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.ResultsAmong 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).ConclusionIn 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.