title: Calcium supplementation after parathyroidectomy in dialysis and renal transplant patients.
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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Nephrology Department, Omaha, NE, USA.
authors.forename: Marius C
authors.initials: MC
authors.lastname: Florescu
authors.affiliation: Institute of Public Health, Omaha, NE, USA.
authors.forename: Km Monirul
authors.initials: KM
authors.lastname: Islam
authors.affiliation: Nephrology Department, Omaha, NE, USA.
authors.forename: Troy J
authors.initials: TJ
authors.lastname: Plumb
authors.affiliation: Department of Pharmacy, The Nebraska Medical Center, Omaha, NE, USA.
authors.forename: Sara
authors.initials: S
authors.lastname: Smith-Shull
authors.affiliation: Department of Pharmacy, The Nebraska Medical Center, Omaha, NE, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Nieman
authors.affiliation: Nephrology Department, Omaha, NE, USA.
authors.forename: Prasanti
authors.initials: P
authors.lastname: Mandalapu
keywords: hungry bone syndrome; hypocalcemia; parathyroidectomy