Post-Parathyroidectomy Predictors of Hungry Bone Syndrome Identified

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Predictors of hungry bone syndrome after parathyroidectomy include lower pre- and post-op calcium levels, according to a new study.
Predictors of hungry bone syndrome after parathyroidectomy include lower pre- and post-op calcium levels, according to a new study.
The following article is part of conference coverage from the NKF 2018 Spring Clinical Meetings in Austin hosted by the National Kidney Foundation. Renal & Urology News staff will be reporting on medical studies conducted by nephrologists and other specialists who are tops in their field in chronic kidney disease, dialysis, transplantation, and more. Check back for the latest news from NKF 2018.

AUSTIN, Texas—Recently identified predictors of hungry bone syndrome (HBS) after parathyroidectomy (PTx) may aid in future risk stratification and surgical planning, researchers reported at the National Kidney Foundation's 2018 Spring Clinical meetings.

A team from Vanderbilt University Medical Center in Nashville, Tennessee, compared 20 HBS and 30 non-HBS patients who underwent successful PTx for uremic hyperparathyroidism in the previous 7 years. The researchers defined HBS as persistent hypocalcemia (less than 7.5 mg/dL) within 24 hours of surgery despite therapy including 2 to 4 g elemental calcium daily, high calcium bath hemodialysis, or progression to IV calcium drip.

Results showed that HBS patients had significantly elevated levels of preoperative parathyroid hormone (2744 vs 1618 pg/mL) and alkaline phosphatase (403 vs 165 IU/L). They also had lower pre- (mean 9.3 vs 10.4 mg/dL) and post-op (mean 6.6 vs 8.5 mg/dL) calcium levels. HBS patients were more likely to receive pre-op calcitriol: 73.3% vs 26.7%. Their mean dialysis vintage also was longer: 79 vs 47 months.

For a quarter of patients, requiring a greater amount of elemental calcium soon after surgery (mean 2.6 vs 1.5 g/d) was associated with subsequent IV calcium drip use and longer hospital length of stay  (mean 5.1 vs 2.9 days).

“Early utilization of these predictors may impact perioperative treatment planning, patient counsel, optimal surgical timing, and HBS risk stratification after surgery,” Kathleen C. Gallagher and her colleagues concluded.

Factors that did not appear to affect HBS included cinacalcet use, total gland weight, and readmissions.

See more coverage from the National Kidney Foundation Spring Clinical meeting

Reference

Gallagher KC, Campbell BR, Solorzano CC, and Baregamian N. Predictors of uremic hungry bone syndrome after parathyroidectomy. Poster presented at the National Kidney Foundation's 2018 Spring Clinical Meetings in Austin, Texas, April 10–14, 2018. Poster 168.

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