Risk factors and clinical course of hungry bone syndrome after total parathyroidectomy in dialysis patients with secondary hyperparathyroidism

Ho, Lo-Yi; Wong, Ping‐Nam; Sin, Ho-Kwan; Wong, Yuk-Yi; Chan, Shuk-Fan; Lo, Mimi; Lo, Kin‐Yee; Mak, Siu‐Ka; Wong, Andrew K.

doi:10.1186/s12882-016-0421-5

Cited by 93 publications

(131 citation statements)

References 24 publications

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“…Hypocalcemia, due to hungry bone syndrome, defined as serum total calcium concentration < 8.4 mg/dL and/or prolonged hypocalcemia for > 4 days post-PTX, is the most commonly reported complication (27%) [ 95 ]. Risk factors include higher body weight, younger age, higher preoperative serum alkaline phosphatase and lower preoperative serum calcium levels [ 96 , 97 ]. Hungry bone disease has been linked to prolonged length of stay and requires aggressive treatment with calcium and vitamin D supplementation.…”

Section: Parathyroidectomy As a Treatment For Persistent Post-transplmentioning

confidence: 99%

Management of Post-transplant Hyperparathyroidism and Bone Disease

Santos

Rossi

Coyne

et al. 2019

Drugs

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Significant advances in immunosuppressive therapies have been made in renal transplantation, leading to increased allograft and patient survival. Despite improvement in overall patient survival, patients continue to require management of persistent post-transplant hyperparathyroidism. Medications that treat persistent hyperparathyroidism include vitamin D, vitamin D analogues, and calcimimetics. Medication side effects such as hypocalcemia or hypercalcemia, and adynamic bone disease, may lead to a decrease in the drugs. When medical management fails to control persistent post-transplant hyperparathyroidism, treatment is a parathyroidectomy. Surgical techniques are not uniform between centers and surgeons. Undergoing the surgery may include a subtotal technique or a technique including total parathyroid gland resection with partial heterotopic gland reimplantation. In addition, there are possible post-surgical complications. The ideal treatment for persistent post-transplant hyperparathyroidism is the treatment and prevention of the condition while patients are being managed for their late-stage chronic kidney disease and end-stage renal disease.

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Section: Parathyroidectomy As a Treatment For Persistent Post-transplmentioning

confidence: 99%

Management of Post-transplant Hyperparathyroidism and Bone Disease

Santos

Rossi

Coyne

et al. 2019

Drugs

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“…The independent risk factors predisposing to its development were high pre‐MWA iPTH levels (or dramatic reductions in iPTH levels), low pre‐MWA serum calcium levels, multiple ablated glands, and a lack of pruritus symptoms. High pre‐MWA iPTH (or dramatic reductions in iPTH), high serum phosphorus, and low pre‐MWA serum calcium have been reported in previous studies basing on PTX . These findings can be mainly explained by hungry bone syndrome (HBS).…”

Section: Discussionmentioning

confidence: 86%

Risk Factors of Severe Hypocalcemia After US-Guided Percutaneous Microwave Ablation of the Parathyroid Gland in Patients with Secondary Hyperparathyroidism

Wei

Peng

Zhao

et al. 2019

Journal of Bone and Mineral Research

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Our aim was to identify potential risk factors associated with severe hypocalcemia (SH) after microwave ablation (MWA) in patients with secondary hyperparathyroidism (SHPT). This retrospective cross‐sectional study enrolled 204 consecutive patients (with 387 parathyroid glands) who underwent MWA between July 2015 and May 2018. Clinical parameters, laboratory indices, and parathyroid gland characteristics were analyzed to assess risk factors associated with SH after MWA. SH was defined as serum calcium level lower than 1.875 mmol/L (7.5 mg/dL) after MWA. Two models (I and II) for pre‐MWA and post‐MWA prediction were established, respectively. In accordance with the KDIGO guidelines, the target value for intact parathyroid hormone (iPTH) less than 300 pg/mL within 7 days after MWA was considered as a successful procedure. The success rate of MWA was 71.6% (146/204). The incidence of hypocalcemia and SH after MWA was 35.8% and 22.06%, respectively. The pre‐MWA prediction models I and II showed that high pre‐MWA iPTH, a dramatic reduction in iPTH, low pre‐MWA serum calcium, multiple ablated gland, and lack of pruritus symptoms were risk factors for developing SH. The accuracy (82.23% versus 83.25% in models I and II, respectively), sensitivity (34.88% versus 44.19%), specificity (95.45% versus 94.59%), positive predictive value (PPV) (68.18% versus 70.37%), and negative predictive value (NPV) (84% versus 85.37%) of both models were promising. The logistic regression fitting of the nomograms showed high prediction efficiency (0.845 and 0.863). High pre‐MWA iPTH, dramatic reductions in iPTH, low pre‐MWA serum calcium, multiple gland ablation, and no pruritus symptoms were predictors of SH. © 2019 American Society for Bone and Mineral Research.

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“…Serum ALP value in the patients with chronic renal failure in uremic stage can re ect the severity of renal osteodystrophy, that is, the severity of bone hunger syndrome after operation. Kidney Disease: Improving Global Outcomes (KDIGO) suggests that Serum ALP value in blood can be used to evaluate the severity of CKD-MBD [1] .Ho LY and other scholars [16] have con rmed that the higher the preoperative ALP value is, the greater the probability of hypocalcaemia is after surgery, and the more the calcium dose needs to be supplemented. This study combines with preoperative ALP value to determine the degree of bone hunger in the whole body and indirectly guide the time of postoperative calcium regulation, especially the preoperative ALP value is greater than 243.43 U/L, that is, the higher the preoperative ALP value is, the greater the degree of bone hunger is, the longer the time of calcium supplementation is, that is necessary to strictly implement a calcium regulation programme to avoid hypocalcaemia caused by premature suspension or reduction of calcium pumping.…”

Section: Discussionmentioning

confidence: 99%

A simple, sustained and sufficient calcium regulation scheme during perioperative period for the secondary hyperparathyroidism

Zhang

Dong

et al. 2020

Preprint

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Background: Patients of secondary hyperparathyroidism (SHPT) with chronic renal failure treated by long-term dialysis have received surgical treatment. The severe complications, especially convulsions caused by severe hypocalcemia, would endanger lives during perioperative treatment. Therefore, this study aims to explore a simple, sustained and sufficient calcium regulation scheme during perioperative period, which could stabilize blood calcium concentration and correct calcium deficiency, greatly reduce the occurrence of the complications.Methods: We reviewed the clinical data of 136 patients with chronic renal failure in uremic stage from Jinzhou Central Hospital and the Second Affiliated Hospital of Dalian Medical University, who received dialysis treatment for a long time and finally diagnosed as secondary hyperparathyroidism, from Jan 2017 to Dec 2019, were accepted different operations to treat hyperparathyroidism, were given corresponding calcium regulation therapy to avoid serious complications were, and were divided into the observation group and the control group according to the postoperative calcium regulation time of ≤7 days and > 7 days, which is defined by the mean time of postoperative calcium regulation, and by the time from the day of operation until the day when the patients have stable blood calcium levels and no obvious discomfort symptoms.Results: Compared with the control group, the observation group were elder (54.01±9.215, P<0.01), shorter preoperative dialysis time (5.05±2.855, P<0.01), significant difference in operation mode (P=0.026), positive preoperative oral calcium(c2=9.941, P=0.002), higher preoperative calcium value (t=4.795, P<0.001), lower preoperative Parathyroid Hormone(PTH) value (t=6.327, P<0.001), lower preoperative Alkaline phosphatase (ALP) value (t=3.527, P=0.001). Multivariate analysis showed that age, preoperative calcium value, preoperative PTH value and preoperative ALP value were independent risk factors for postoperative calcium regulation therapy. Those factors, Gender, preoperative dialysis mode, complications, preoperative Hemoglobin(HB) value, were not related to postoperative calcium regulation. There was no significant difference between the two groups (P>0.05).Conclusion: The simple, sustained and sufficient calcium regulation scheme can maintain a stable level of blood calcium in the dialytic CKD patients with secondary hyperparathyroidism, so as to avoid the occurrence of severe hypocalcemia and increase the curate.

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Risk factors and clinical course of hungry bone syndrome after total parathyroidectomy in dialysis patients with secondary hyperparathyroidism

Cited by 93 publications

References 24 publications

Management of Post-transplant Hyperparathyroidism and Bone Disease

Management of Post-transplant Hyperparathyroidism and Bone Disease

Risk Factors of Severe Hypocalcemia After US-Guided Percutaneous Microwave Ablation of the Parathyroid Gland in Patients with Secondary Hyperparathyroidism

A simple, sustained and sufficient calcium regulation scheme during perioperative period for the secondary hyperparathyroidism

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