The incidence of hyperkalemia in patients with secondary hyperparathyroidism after ultrasound-guided radiofrequency ablation vs. parathyroidectomy

TL;DR

This study compares how often high blood potassium occurs after two treatments for a thyroid condition in dialysis patients, finding one method causes it more often.

Contribution

The study identifies parathyroidectomy as a significant risk factor for postoperative hyperkalemia and establishes a preoperative potassium threshold for risk prediction.

Findings

53 out of 154 patients (34.4%) developed hyperkalemia after treatment.

Preoperative serum potassium and parathyroidectomy were independent risk factors for hyperkalemia.

The optimal preoperative potassium threshold to predict hyperkalemia was 4.66 mmol/L.

Abstract

The aim of our study was to compare the incidence of hyperkalemia in maintenance dialysis patients with secondary hyperparathyroidism(SHPT) after parathyroidectomy(PTX) or ultrasound-guided radiofrequency ablation(RFA), and to explore the risk factors and the best preoperative serum potassium threshold.

We defined hyperkalemia as serum potassium >5.30 mmol/L. Two operation methods were analyzed in subgroups, and the differences in demographic parameters, operation situation and perioperative laboratory indicators were compared between the two groups.

A total of 154 maintenance dialysis patients were included, of which 91 patients received PTX and 63 patients received RFA. 53 patients (34.4%) developed postoperative hyperkalemia. Patients in hyperkalemia group had higher preoperative serum potassium, phosphorus, hemoglobin and 25-hydroxyvitamin D level (p < 0.05). It seemed that males were more prone to suffer hyperkalemia than females, but there was no statistically difference (40.9% vs. 25.8%, p = 0.05). The occurrence of hyperkalemia after the operation was obviously higher in hemodialysis patients. Logistic regression analysis showed that preoperative serum potassium level (OR = 3.269, 95%CI 1.638–6.534, p = 0.001) and PTX (OR = 18.119, 95%CI 5.716–57.438, p < 0.01) were independent risk factors for predicting postoperative hyperkalemia. According to ROC curve analysis, the optimal cutoff value for preoperative serum potassium was 4.66 mmol/L, with a sensitivity of 46.8% and a specificity of 86%.

Hyperkalemia after invasive treatment in patients with severe SHPT was common, and the incidence of hyperkalemia after PTX was significantly higher than that after RFA. Hemodialysis patients were more prone to hyperkalemia, which was related to the preoperative serum potassium level.

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