Surgical management of renal hyperparathyroidism in the dialysis patient.

Over 12 years, 49 patients with hyperparathyroidism secondary to chronic renal failure under treatment with hemodialysis were treated with total parathyroidectomy. A portion of one gland was implanted in the sternocleidomastoid muscle. The operative indications were elevation of parathormone, serum calcium, and phosphorus, levels, pruritus, bone pain, pathologic fractures, and myalgia. Special postoperative complications discussed are hyperkalemia, hemorrhage, and respiratory obstruction. There were no operative deaths. No postoperative tetany was seen. Total parathyroidectomy should be performed in chronic renal failure patients with persistent elevation of serum calcium and parathormone levels, and who have pain, fractures, or soft tissue calcification. All postoperative parathyroidectomy patients should be observed for possible hyperkalemia.