Incidence of and risk factors for post-parathyroidectomy hungry bone syndrome in patients with secondary hyperparathyroidism

Abstract

Background Hungry bone syndrome (HBS) following parathyroidectomy is associated with severe hypocalcemia and increased morbidity. This study aims to determine the incidence and risk factors of post-parathyroidectomy HBS in dialysis patients with secondary hyperparathyroidism (SHPT). Methods A retrospective cohort study was conducted, and medical records of patients with SHPT requiring parathyroidectomy between January 2014 and January 2020 were reviewed. HBS was defined as the requirement of intravenous calcium administration due to hypocalcemia-related symptoms and/or reductions in serum calcium concentration (<8.4 mg/dL) within 72 h after parathyroidectomy. Results A total of 130 dialysis patients were enrolled. The majority of patients (85.4%) received hemodialysis and the remaining patients (14.6%) received peritoneal dialysis. Ectopic parathyroid glands were identified in 6.6% of patients by preoperative parathyroid scintigraphy. Diffuse parathyroid hyperplasia was the most common histopathological characteristic of SHPT (90.8%). HBS occurred in 82.3% of patients following parathyroidectomy. Preoperative serum intact parathyroid hormone (iPTH) concentration was significantly correlated with serum calcium ( r = −0.48, p < 0.01) and alkaline phosphatase (ALP) concentration ( r = 0.71, p < 0.01). Patients with HBS had significantly longer hospital stays than patients without (8 versus 3 days, p < 0.01). Based on multiple logistic regression analysis, young age (≤45 years), high preoperative serum ALP (>420 IU/L) and iPTH (>1,000 pg/mL), and absence of preoperative hypercalcemia (>10.2 mg/dL) were significantly associated with HBS. Conclusions Post-parathyroidectomy HBS is common in dialysis patients with SHPT. Young age, high preoperative serum ALP and iPTH, and low preoperative serum calcium concentrations were important risk factors for HBS.

Effect of High Dose Active Vitamin D Therapy on the Development of Hypocalcemia After Subtotal Parathyroidectomy in Patients on Chronic Dialysis

“…The incidence of hypocalcemia after PTx ranges between 27% and 83%. 13,17,25 Our results were similar, where 57.6% of the HDG and 82.2% of the LDG developed hypocalcemia (< 2.0 mmol/l) within the first days. The administration of active vitamin D (calcitriol or alfacalcidol) reduces the incidence of hypocalcemia.…”

“…10,11 Excessive preoperative levels of PTH, alkaline phosphatase (AP) and bone specific AP, low levels of calcium and albumin and young age were recently identified as risk factors for postoperative hypocalcaemia. [12][13][14] The administration of calcium supplements and active vitamin D to increase intestinal calcium absorption has long been standard in treating and preventing hypocalcemia after PTx. 11,[15][16][17] Moreover, bisphosphonates were effective lowering the incidence of HBS.…”

Risk factors for hypocalcemia in dialysis patients with refractory secondary hyperparathyroidism after parathyroidectomy: a meta-analysis

“…In total, five studies mentioned the results of age [ 5 , 14 , 15 , 18 , 19 ]. The statistical heterogeneity was high (I 2 =82%, p = 0.0002), and a random-effects model was used to perform a meta-analysis was performed on the unadjusted data.…”

“…A total of 11 studies (including 13 groups of data) provided the results of preoperative ALP [ 2 , 5 , 8 , 13 , 14 , 17–22 ]. The statistical heterogeneity was high with I 2 =90% ( p < 0.00001).…”

Risk Factors for Severe Hypocalcemia in Patients with Secondary Hyperparathyroidism after Total Parathyroidectomy

“…Old age, the size of the resected parathyroid glands, the preoperative serum iPTH level, and the preoperative serum alkaline phosphatase (ALP) level were found to be risk factors for SH after parathyroidectomy in patients with primary hyperparathyroidism [10][11][12][13]. Also, there is a study with controversial results that indicated young age was a risk factor for HBS [14]. Further, the preoperative iPTH and ALP levels were reported as risk factors for SH after parathyroidectomy in SHPT patients.…”