title: Incidence of and risk factors for hungry bone syndrome in 84 patients with secondary hyperparathyroidism.
abstract: BACKGROUND
  Secondary hyperparathyroidism develops in nearly all patients with end-stage renal disease. Parathyroidectomy is often performed when medical therapy fails. The most common postoperative complication, hungry bone syndrome (HBS), requires early recognition and treatment.
  
  
  METHODS
  A total of 84 patients who underwent parathyroidectomy because of secondary hyperparathyroidism were investigated. Detailed analysis of laboratory parameters (calcium, phosphate, parathyroid hormone, hemoglobin, and urea levels) and baseline characteristics (age at time of surgery, duration of renal replacement therapy, and medication) was performed to detect preoperative predictors for the development of HBS.
  
  
  RESULTS
  Average overall follow-up of the cohort was 4.7 years. Within this time frame, 13 of 84 patients had to undergo a second surgery because of recurrent disease, and HBS occurred in 51.2%. Only decreased preoperative calcium levels and younger age at time of surgery were significant predictors of HBS. Minimal levels of calcium were detected 3 weeks after surgery. Preoperative vitamin D therapy could not prevent HBS and could not shorten the duration of intravenous calcium supplementation.
  
  
  CONCLUSIONS
  HBS is a very common complication after parathyroidectomy. Younger patients and patients with low preoperative calcium levels were at higher risk for the development of HBS. Remarkably, preoperative vitamin D therapy could not prevent HBS and had no impact on the length of intravenous calcium supplementation. Intensive monitoring of calcium levels must be performed for at least 3 weeks after surgery.
authors.affiliation: Department of Internal Medicine, Division of Nephrology, Robert Bosch Hospital, Stuttgart, Germany.
authors.forename: Joerg
authors.initials: J
authors.lastname: Latus
authors.forename: Meike
authors.initials: M
authors.lastname: Roesel
authors.forename: Peter
authors.initials: P
authors.lastname: Fritz
authors.forename: Niko
authors.initials: N
authors.lastname: Braun
authors.forename: Christoph
authors.initials: C
authors.lastname: Ulmer
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Steurer
authors.forename: Dagmar
authors.initials: D
authors.lastname: Biegger
authors.forename: M Dominik
authors.initials: MD
authors.lastname: Alscher
authors.forename: Martin
authors.initials: M
authors.lastname: Kimmel
keywords: hungry bone syndrome; parathyroidectomy; secondary hyperparathyroidism