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. 2014 May 14:7:183-90.
doi: 10.2147/IJNRD.S56995. eCollection 2014.

Calcium supplementation after parathyroidectomy in dialysis and renal transplant patients

Marius C Florescu  1 , Km Monirul Islam  2 , Troy J Plumb  1 , Sara Smith-Shull  3 , Jennifer Nieman  3 , Prasanti Mandalapu  1
Affiliations

Calcium supplementation after parathyroidectomy in dialysis and renal transplant patients

Marius C Florescu et al. Int J Nephrol Renovasc Dis. .

Abstract

Background: Data on the risk factors and clinical course of hungry bone syndrome are lacking in dialysis and renal transplant patients who undergo parathyroidectomy. In this study, we aimed to assess the risks and clinical course of hungry bone syndrome and calcium repletion after parathyroidectomy in dialysis and renal transplant patients.

Methods: We performed a retrospective review of parathyroidectomies performed at The Nebraska Medical Center.

Results: We identified 41 patients, ie, 30 (73%) dialysis and eleven (27%) renal transplant patients. Dialysis patients had a significantly higher pre-surgery intact parathyroid hormone (iPTH, P<0.001) and a larger iPTH drop after surgery (P<0.001) than transplant recipients. Post-surgery hypocalcemia in dialysis patients was severe and required aggressive and prolonged calcium replacement (11 g) versus a very mild hypocalcemia requiring only brief and minimal replacement (0.5 g) in transplant recipients (P<0.001). Hypophosphatemia was not detected in the dialysis group. Phosphorus did not increase immediately after surgery in transplant recipients. The hospital stay was significantly longer in dialysis patients (8.2 days) compared with transplant recipients (3.2 days, P<0.001).

Conclusion: The clinical course of hungry bone syndrome is more severe in dialysis patients than in renal transplant recipients. Young age, elevated alkaline phosphatase, elevated pre-surgery iPTH, and a large decrease in post-surgical iPTH are risk factors for severe hungry bone syndrome in dialysis patients.

Keywords: hungry bone syndrome; hypocalcemia; parathyroidectomy.

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Figures

Figure 1
Figure 1
Mean iPTH (ng/L) levels before and after surgery in dialysis and transplant groups. Abbreviation: iPTH, intact parathyroid hormone.
Figure 2
Figure 2
Comparison between dialysis and transplant patients of mean oral and intravenous elemental calcium (g) administered after parathyroidectomy per patient during hospital admission (P<0.001). Abbreviations: IV, intravenous; Ca, calcium.
Figure 3
Figure 3
Comparison of length of admission (days) between dialysis and transplant patients (P<0.001).
See this image and copyright information in PMC

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