Alkaline phosphatase predicts calcium requirements after total parathyroidectomy in patients receiving dialysis

Background: It can be difficult to achieve a stable serum calcium level after parathyroidectomy for renal hyperparathyroidism. This study examined the impact of a calcium replacement protocol guided by predicted need in reducing hospital stay. Methods: This two-phase observational study included patients receiving dialysis who underwent parathyroidectomy. In the initial phase, a standard protocol was followed whereby oral calcium was gradually titrated upwards based on serum calcium levels. The protocol was revised in the second phase such that patients were ‘loaded’ with the predicted elemental calcium requirement immediately after surgery. Results: Forty-four patients were treated according to the standard protocol and 34 using the new protocol. There was a strong correlation between postoperative elemental calcium requirement and admission serum alkaline phosphatase level (ALP) (rs = 0·711, P < 0·001). Postoperative hospital stay was reduced from a median (range) of 5 (3–12) to 3 (2–7) days after introduction of the revised protocol as a result of better calcium balance (P < 0·001). Multivariable analysis confirmed that use of the revised protocol was the main predictor of length of stay. Conclusion: ALP can predict postoperative calcium requirements and streamline hospital stay by guiding replacement therapy. Copyright © 2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.