Abstract: FR-PO295

Risk Factors for Hungry Bone Syndrome after Parathyroidectomy in CKD Patients on Dialysis

Session Information

Category: Mineral Disease

  • 1202 Mineral Disease: Vitamin D, PTH, FGF-23

Authors

  • Fonseca-Correa, Jorge Ignacio, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, México City, Mexico
  • Herrera-Hernández, Miguel, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, México City, Mexico
  • Correa-Rotter, Ricardo, Institutor Nacional de la Nutricion, Mexico City, Mexico
  • Ramirez-Sandoval, Juan Carlos, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, México city, Distrito Federal, Mexico
  • Rojas-Concha, Luis, Instituto Nal Ciencias Med y Nutricion Salvador Zubiran, Puebla, Mexico
  • Madrazo-Ibarra, Antonio, Escuela de Medicina, Universidad Panamericana, Mexico City, Mexico
  • Martínez-Delfín, Pindaro S, Escuela de Medicina, Universidad Panamericana, Mexico City, Mexico
  • Zinser-Peniche, Paola, Universidad Panamericana, CDMX, Mexico
  • Pantoja, Juan Pablo, Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubirán, Mexico, Mexico
  • Sierra-Salazar, Mauricio, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, México City, Mexico
  • VELAZQUEZ-FERNANDEZ, David, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
Background

Hungry bone syndrome (HBS) is a frequent event after parathyroidectomy (PTx). While risk factors for HBS are well known in primary hyperparathyroidism (HPT), it is unclear whether these risk factors are similar in secondary or tertiary HPT.

Methods

We retrospectively analyzed the risk factors for HBS of a single-center cohort of 68 dialysis patients who underwent PTx. We defined HBS as persistent hypocalcemia (corrected calcium <7.5 mg/dL) lasting >3 days -with or without hypophosphatemia- requiring extended hospital stay for intravenous calcium supplementation. All patients were followed up for one year.

Results

HBS occurred in 36 (53%) patients. In the bivariate analysis, a higher preoperative intact parathyroid hormone (iPTH) (1984±777 vs. 940±581 pg/mL; p<0.001), a higher alkaline phosphatase (ALP) (706 [322-1155] vs. 132 [108-233] IU/L; p<0.001), and older dialysis vintage (4 [3-4] vs. 6 [4-11] years; p=0.049) independently predicted the development of HBS. Peritoneal dialysis (PD) treatment protected against HBS (68% Non-HBS vs. 47% HBS were on PD; p=0.02). Age, weight, preoperative phosphorus, and type of surgery did not predict HBS occurrence. Calcitriol prophylaxis for >2 days, prescribed in 91% of patients with HBS, was not effective to prevent HBS (median dose of 1.25 mcg/day [IQR 0.75-2.25]). When a multivariate analysis was performed only iPTH and ALP remained as predictors of HBS.
During the year of follow-up, 4 (6%) patients died and 21 (31%) received a kidney transplant. At one year, patients who had HBS needed higher doses of calcium prescription (CaCO3 6.8 gr/day [IQR 4.5-14.8] vs. 1.5 gr/day [IQR 0-3.0]) and calcitriol (0.75 mcg/day [IQR 0.5-1.5] vs. 0.25 mcg/day [IQR 0-0.75].

Conclusion

HBS was a common complication after PTx and closely related to severity of HPT. At one year of follow up it was associated with continued prescription of higher doses of calcium and calcitriol. Consequences of this prolonged exposure to calcium and calcitriol could have deleterious systemic/vascular complications. Preoperative prophylactic calcitriol, prescribed in 91% of those who later developed HBS, was ineffective in preventing the appearance of this syndrome.