Incidence and predictors of hyperkalemia after subtotal parathyroidectomy in pediatric chronic dialysis patients with secondary hyperparathyroidism: a retrospective cohort study.

BACKGROUND

Hyperkalemia is a life-threatening electrolyte complication reported sporadically in adults on chronic dialysis and secondary hyperparathyroidism (SHPT) after parathyroidectomy (PTX), but has never been recorded in pediatric patients. This study aimed to estimate the incidence, explore potential risk factors and early predictive markers associated with its occurrence in children.

METHODS

We conducted a retrospective cohort study that included 21 pediatric patients on chronic dialysis and SHPT who underwent subtotal PTX at a single pediatric center. Patients were divided into two groups based on the development of hyperkalemia. Preoperative, intraoperative, and postoperative biochemical data were analyzed. Univariate comparison and multivariable logistic regression analyses were performed to explore risk factors. Receiver operating characteristic (ROC) curves were used to assess the predictive value of potassium levels.

RESULTS

The cumulative incidence of postoperative hyperkalemia was 42.8%. No preoperative risk factors were identified. However, ROC analysis showed that intraoperative potassium (cutoff: 4.83 mEq/L, AUC: 0.95) and potassium at 6 h postoperatively (cutoff: 5.46 mEq/L, AUC: 0.90) were strong predictors.

CONCLUSIONS

Postoperative hyperkalemia is a frequent, yet underappreciated, complication in pediatric patients on chronic dialysis undergoing subtotal PTX. Intraoperative and early postoperative potassium levels demonstrated high predictive capacity and may help guide early risk stratification and timely intervention. Larger multicenter studies are required to validate these findings.