Effect of Preoperative Calcitriol Administration on Postoperative Hypocalcemia in Dialysis Patients Undergoing Parathyroidectomy: A Randomized Controlled Trial
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Abstract
Background: Secondary hyperparathyroidism is a common complication in patients with end-stage renal disease receiving dialysis, and parathyroidectomy is often required when medical treatment fails. Postoperative hypocalcemia is a frequent and serious complication that contributes to morbidity and prolonged hospitalization. This study aimed to determine whether preoperative administration of calcitriol reduces the severity of postoperative hypocalcemia and the need for parenteral calcium supplementation in dialysis patients undergoing parathyroidectomy.
Method: A single-center, open-label randomized controlled trial was conducted in 26 dialysis patients with severe secondary hyperparathyroidism. Participants were randomly assigned in a 1:1 ratio to receive either calcitriol 2 micrograms per day combined with calcium carbonate 3.6 grams per day for three days before surgery (intervention group, n=13) or calcium carbonate alone (control group, n=13). All patients were followed with serial calcium measurements for at least 72 hours after surgery. The primary outcome was the nadir serum calcium level within 24 hours postoperatively.
Result: Baseline characteristics were similar between groups. The intervention group showed significantly higher nadir serum calcium within 24 hours (8.15±0.57 vs. 7.59±0.56 mg/dL; p=0.020). The intervention group also required a lower total dose of intravenous calcium infusion (1,232.8±883.0 vs. 2,845.5±2,253.2 mg; p=0.024) and a shorter duration (3.6±1.9 vs. 5.6±2.6 days; p=0.036).
Conclusions: Short-term preoperative administration of calcitriol reduced the severity of postoperative hypocalcemia and decreased the requirement for intravenous calcium infusion in dialysis patients undergoing parathyroidectomy. These findings support the role of calcitriol as an effective perioperative strategy, although larger studies are needed to confirm long-term outcomes.
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