Calcium supplementation after parathyroidectomy in dialysis and renal transplant patients

Marius C. Florescu, Km Monirul Islam, Troy J. Plumb, Sara Smith-Shull, Jennifer Nieman, Prasanti Mandalapu

Research output: Contribution to journalArticle

13 Scopus citations

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 identifed 41 patients, ie, 30 (73%) dialysis and eleven (27%) renal transplant patients. Dialysis patients had a signifcantly 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 signifcantly 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.

Original languageEnglish (US)
Pages (from-to)183-190
Number of pages8
JournalInternational Journal of Nephrology and Renovascular Disease
Volume7
DOIs
StatePublished - May 14 2014

Keywords

  • Hungry bone syndrome
  • Hypocalcemia
  • Parathyroidectomy

ASJC Scopus subject areas

  • Nephrology

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