Hypocalcemia-based prediction of hungry bone syndrome after parathyroidectomy in hemodialysis patients with refractory secondary hyperparathyroidism

Objective This study was performed to explore the risk factors for hungry bone syndrome (HBS) and establish prediction equations for calcium supplementation after parathyroidectomy in hemodialysis patients with secondary hyperparathyroidism. Methods We retrospectively analyzed data from 252 hemodialysis patients undergoing successful total parathyroidectomy with autotransplantation. HBS was defined according to a minimum postoperative serum corrected calcium (PcCa) concentration of <2.0 mmol/L. Independent predictors of HBS were analyzed, and prediction equations for HBS were derived accordingly. Results The incidence of HBS was 71.4%. The serum corrected calcium and preoperative serum alkaline phosphatase (ALP) concentrations were independent predictors of HBS. The preoperative serum ALP, intact parathyroid hormone (iPTH), and hemoglobin concentrations were independent factors influencing the average descending velocity of the PcCa concentration before calcium supplementation (PcCa-V), intravenous calcium supplement holding time (IVCa-T), and intravenous calcium supplement dosage (IVCa), while the serum ALP and iPTH concentrations were independent predictors of the oral calcium supplement dosage (OCa). Four prediction equations for PcCa-V, IVCa-T, IVCa, and OCa were established. Conclusions Establishment of prediction equations for HBS may contribute to a new individualized therapy for patients with HBS.

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

BMC Nephrology ◽

10.1186/s12882-016-0421-5 ◽

2017 ◽

Vol 18 (1) ◽

Cited By ~ 36

Author(s):

Lo-Yi Ho ◽

Ping-Nam Wong ◽

Ho-Kwan Sin ◽

Yuk-Yi Wong ◽

Kwok-Chi Lo ◽

...

Keyword(s):

Risk Factors ◽

Secondary Hyperparathyroidism ◽

Clinical Course ◽

Total Parathyroidectomy ◽

Dialysis Patients ◽

Hungry Bone Syndrome ◽

Hungry Bone

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Risk Factors for Elevated Preoperative Alkaline Phosphatase in Patients with Refractory Secondary Hyperparathyroidism

The American Surgeon ◽

10.1177/000313481708301220 ◽

2017 ◽

Vol 83 (12) ◽

pp. 1368-1372 ◽

Cited By ~ 1

Author(s):

Meng Yang ◽

Ling Zhang ◽

Linping Huang ◽

Xiaoliang Sun ◽

Haoyang Ji ◽

...

Keyword(s):

Alkaline Phosphatase ◽

Secondary Hyperparathyroidism ◽

Calcium Supplementation ◽

Univariate Analysis ◽

Total Parathyroidectomy ◽

Postoperative Hypocalcemia ◽

Preoperative Serum ◽

Significant Independent Risk Factor ◽

Risk Patients ◽

Optimal Cutoff Point

Elevated preoperative levels of alkaline phosphatase (ALP) in patients with refractory secondary hyperparathyroidism are correlated with postoperative hypocalcemia and mortality. The aim of this study was to identify the predictors of preoperative ALP in patients with secondary hyperparathyroidism. From April 2012 to December 2015, 220 patients with refractory secondary hyperparathyroidism undergoing total parathyroidectomy without autotransplantation were reviewed. A total of 164 patients presented with elevated preoperative ALP. Univariate analysis showed that patients with elevated ALP were significantly younger. The elevated ALP group had significantly higher levels of preoperative parathyroid hormone (PTH), lower preoperative serum calcium, higher preoperative phosphorus, lower postoperative hypocalcemia, and a longer hospital stay. Logistic regression analysis showed that elevated preoperative PTH was a significant independent risk factor for elevated preoperative ALP (P = 0.000), and its value of 1624 pg/mL was the optimal cutoff point. Factors predictive of elevated preoperative ALP in patients with secondary hyperparathyroidism include preoperative PTH. Earlier surgery, aggressive calcium supplementation, and more careful or aggressive postoperative care for high-risk patients are needed.

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Fatal Hypocalcaemia Due to Hungry Bone Syndrome with Secondary Refractory HyperParathyroidism after Parathyroidectomy: A Case Report

The Journal of Critical Care Medicine ◽

10.2478/jccm-2019-0021 ◽

2019 ◽

Vol 5 (4) ◽

pp. 140-144

Author(s):

Corina Pop Radu ◽

Valentin Daniealopol ◽

Ario Santini ◽

Ruxandra Darie ◽

Daniela Tatiana Sala

Keyword(s):

Case Report ◽

Cardiopulmonary Resuscitation ◽

Initial Period ◽

Parathyroid Tissue ◽

Total Parathyroidectomy ◽

Cardiac Symptoms ◽

Hungry Bone Syndrome ◽

Ionic Calcium ◽

Hungry Bone ◽

Secondary Refractory

Abstract Introduction Hungry bone syndrome (HBS) refers to the rapid, profound, and prolonged hypocalcaemia associated with hypophosphatemia and hypomagnesaemia, and is exacerbated by suppressed parathyroid hormone (PTH) levels, which follows parathyroidectomy in patients with severe primary hyperparathyroidism (PHPT) and preoperative high bone turnover. [1] Case report This report concerns a dialysed patient who underwent surgical treatment for secondary refractory hyperparathyroidism. Haemodialysis was carried out pre-operatively, and subsequently, a total parathyroidectomy with auto-transplantation of parathyroid tissue in the sternocleidomastoid muscle (SCM) was performed. Rapid and progressive hypocalcaemia symptoms developed during the second day postoperatively. Acute cardiac symptoms with tachyarrhythmia, haemodynamic instability and finally asystole occurred, which required cardiopulmonary resuscitation (CPR). The ionic calcium level was 2.2 mg/dL being consistent with a diagnosis of HBS. A second cardiac arrest unresponsive to CPR followed an initial period of normal sinus rhythm. Death ensued shortly after. Before death, the ionic calcium was 3.1 mg/dL. Conclusion HBS, after parathyroidectomy in patients with secondary hyperparathyroidism (SHPT), may be severe, prolonged and sometimes fatal. Generally, HBS symptomatology is that of a mild hypocalcaemia. It can, however, include heart rhythm disturbances with haemodynamic alterations requiring intensive care measurements and even cardiopulmonary resuscitation. A close clinical and laboratory post-parathyroidectomy monitoring of dialysed patients is of the utmost importance.

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Secondary Hyperparathyroidism

10.2310/7800.16040 ◽

2019 ◽

Author(s):

Anna C Beck ◽

Sonia L Sugg

Keyword(s):

Renal Failure ◽

Chronic Renal Failure ◽

Secondary Hyperparathyroidism ◽

Total Parathyroidectomy ◽

Indications For Surgery ◽

Subtotal Parathyroidectomy ◽

Diagnostic Work ◽

Work Up ◽

Hungry Bone ◽

Diagnostic Work Up

Secondary hyperparathyroidism is defined and its pathophysiology, delineated. Key components of the diagnostic work-up, medical management, and indications for surgery are described. The operative approach and controversy on extent of parathyroidectomy are discussed. This review contains 3 figures, 1 tables, and 24 references. Key Words: autotransplantation, calciphylaxis, chronic renal failure, cryopreservation, hungry bone syndrome, hypocalcemia, secondary hyperparathyroidism, subtotal parathyroidectomy, total parathyroidectomy

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