title: Risk factors and clinical course of hungry bone syndrome after total parathyroidectomy in dialysis patients with secondary hyperparathyroidism.
abstract: Hungry bone syndrome (HBS) is an important postoperative complication after parathyroidectomy for severe secondary hyperparathyroidism (SHPT). There is, however, little data in the literature on its detailed clinical course, and the associated risk factors remain controversial.
  
  
  
  We did a single-center retrospective study on 62 consecutive dialysis patients who underwent total parathyroidectomy for SHPT to examine the risk factors, clinical course and outcome. Data on demographic characteristics, perioperative laboratory parameters including serum calcium, phosphate, alkaline phosphatase (ALP) and parathyroid hormone (PTH), drug treatment for SHPT and operative details of parathyroidectomy were collected.
  
  
  
  Seventeen (27.4%) patients developed severe postoperative hypocalcemia with HBS. The serum calcium dropped progressively while serum ALP rose after operation until 2 weeks later when serum calcium reached the trough and serum ALP peaked. Serum phosphate also fell but stabilized between 4 and 14 days. The total postoperative calcium and vitamin D supplementation was significantly larger, and hospital stay was significantly longer in the group with HBS as compared with those without HBS. Young age, high body weight, high preoperative ALP level, and low preoperative calcium level independently predicted the development of HBS while preoperative PTH and use of cinacalcet or paricalcitol did not.
  
  
  
  HBS was common after total parathyroidectomy in patients with SHPT, and it is important to closely monitor the postoperative serum calcium, phosphate and ALP levels in the following 2 weeks, especially for those at risk. The implications of our findings on perioperative management are discussed.
authors.affiliation: Department of Medicine & Geriatrics, Kwong Wah Hospital, 25 Waterloo Road, Kowloon, Hong Kong SAR, China.
authors.forename: Lo-Yi
authors.initials: LY
authors.lastname: Ho
authors.affiliation: Department of Medicine & Geriatrics, Kwong Wah Hospital, 25 Waterloo Road, Kowloon, Hong Kong SAR, China. wongpn@ha.org.hk.
authors.forename: Ping-Nam
authors.initials: PN
authors.lastname: Wong
authors.affiliation: Department of Medicine & Geriatrics, Kwong Wah Hospital, 25 Waterloo Road, Kowloon, Hong Kong SAR, China.
authors.forename: Ho-Kwan
authors.initials: HK
authors.lastname: Sin
authors.affiliation: Department of Medicine & Geriatrics, Kwong Wah Hospital, 25 Waterloo Road, Kowloon, Hong Kong SAR, China.
authors.forename: Yuk-Yi
authors.initials: YY
authors.lastname: Wong
authors.affiliation: Department of Medicine & Geriatrics, Kwong Wah Hospital, 25 Waterloo Road, Kowloon, Hong Kong SAR, China.
authors.forename: Kwok-Chi
authors.initials: KC
authors.lastname: Lo
authors.affiliation: Department of Medicine & Geriatrics, Kwong Wah Hospital, 25 Waterloo Road, Kowloon, Hong Kong SAR, China.
authors.forename: Shuk-Fan
authors.initials: SF
authors.lastname: Chan
authors.affiliation: Department of Medicine & Geriatrics, Kwong Wah Hospital, 25 Waterloo Road, Kowloon, Hong Kong SAR, China.
authors.forename: Man-Wai
authors.initials: MW
authors.lastname: Lo
authors.affiliation: Department of Medicine & Geriatrics, Kwong Wah Hospital, 25 Waterloo Road, Kowloon, Hong Kong SAR, China.
authors.forename: Kin-Yee
authors.initials: KY
authors.lastname: Lo
authors.affiliation: Department of Medicine & Geriatrics, Kwong Wah Hospital, 25 Waterloo Road, Kowloon, Hong Kong SAR, China.
authors.forename: Siu-Ka
authors.initials: SK
authors.lastname: Mak
authors.affiliation: Department of Medicine & Geriatrics, Kwong Wah Hospital, 25 Waterloo Road, Kowloon, Hong Kong SAR, China.
authors.forename: Andrew Kui-Man
authors.initials: AK
authors.lastname: Wong
mesh_terms: D000328:Adult; D000469:Alkaline Phosphatase / Q000378:metabolism; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D002118:Calcium / Q000378:metabolism; D002136:Calcium, Dietary / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000209:etiology / Q000601:surgery*; D006996:Hypocalcemia / Q000188:drug therapy / Q000378:metabolism*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000378:metabolism; D016105:Parathyroidectomy; D010710:Phosphates / Q000378:metabolism; D011183:Postoperative Complications / Q000188:drug therapy / Q000378:metabolism*; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014807:Vitamin D / Q000627:therapeutic use
chemical_list: D050071:Bone Density Conservation Agents; D002136:Calcium, Dietary; D010281:Parathyroid Hormone; D010710:Phosphates; D014807:Vitamin D; D000469:Alkaline Phosphatase; D002118:Calcium
keywords: Dialysis; Hypocalcaemia; Metabolic bone disease; Parathyroidectomy; Secondary hyperparathyroidism