Table 1 Clinical and laboratory characteristics of our patient before and after parathyroidectomy

Start of dialysis (12/2015)

No medication

Start of dialysis in emergency

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Biochemical data: BUN: 245 mg/dl (40.8 mmol/l), creatinine: 18.43 mg/dl (1630 umol/l), bicarbonates: 13 mmol/l, albumin: 2.6 g/dl; BNP: >  4000 pg/ml.

PTH: >  1500 ng/l; Calcium: 8.52 mg/dl (2.13 mmol/l); Phosphate: 10.49 mg/dl (3.39 mmol/l)

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Predialysis BP: 165–200 mmHg (systolic), 90–130 mmHg (diastolic)

Pre-parathyroidectomy (10/2016)

Medication: Bisoprolol 2.5 mg

Dialysis schedule: 4 h × 3 weekly sessions; access: native AV fistula; Bicarbonate buffer, Ca 1.5 mmol/l, Na 138 mEq/l

Biochemical data: BUN: 41.22 mg/dl (14.7 mmol/l), creatinine: 12.85 mg/dl (1136 umol/l), bicarbonates: 19 mmol/l, BNP: >  1500 pg/ml, Calcium: 10.12 mg/dl (2.53 mmol/l), PTH: 1317 ng/l, ionized Calcium: 5.04 mg/dl (1.26 mmol/l), phosphorus: 7.58 mg/dl (2.45 mmol/l), albumin: 3.5 g/dl, vitamin D 25 OH: 39 μg/l

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Kt/V (Daugirdas 2): 1.7; nPCR: 1.2 g/kg/day

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Predialysis BP: 150–180 (systolic), 90–100 mmHg (diastolic)

First week post parathyroidectomy (11/2016)

Medication: Bisoprolol 2.5 mg, Calcium carbonate 1.54 g (3 times per day), Alfacalcidol 0.5 μg

Dialysis schedule: 4 h × 3 weekly sessions; access: native AV fistula; Bicarbonate buffer, Ca 1.5 mmol/l Na 138 mEq/l

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Biochemical data: BUN: 54.34 mg/dl (9.06 mmol/l), creatinine: 11.48 mg/dl (1015 umol/l), bicarbonates: 19 mmol/l, PTH: 70 ng/l, Calcium: 7.12 mg/dl (1.78 mmol/l); Ionised Calcium: 3.48 mg/dl (0.87 mmol/l), albumin: 3.3 g/dl

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Predialisys BP: 120–135 (systolic), 60–80 mmHg (diastolic)

Four months post parathyroidectomy (02/2017)

Medication: Bisoprolol 2.5 mg, Cholecalciferol 100,000 UI (1 vial per month), Calcium carbonate 1.54 g (2 times per day), Alfacalcidol 1 μg

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Dialysis schedule: 4 h × 3 weekly sessions; access: native AV fistula; Bicarbonate buffer, Ca 1.5 mmol/l, Na 138 mEq/l

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Biochemical data: BUN: 34.39 mg/dl (12.28 mmol/l), creatinine = 12.23 mg/dl (1082 umol/l), bicarbonates: 15 mmol/l, PTH: 199 ng/l, Calcium: 9.2 mg/dl (2.3 mmol/l); Ionised Calcium: 4.84 mg/dl (1.21 mmol/l), albumin: 3.6 g/dl

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Predialysis arterial pressure 120–130 (systolic); 70–85 mmHg (diastolic)

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Kt/V (Daugirdas 2) 1.7; nPCR: 1.2 g/kg/day