Abstract: FR-PO1008
Hungry Bone Syndrome After Parathyroidectomy in a Patient with ESRD on Hemodialysis
Session Information
- Hemodialysis: Clinical Challenges, Patient-Centered Outcomes, and Quality of Life
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Ovalekar, Simran, CORE Kidney Health Program, Los Angeles, California, United States
- Tandon, Ariv, CORE Kidney Health Program, Los Angeles, California, United States
- Simon, Lewis, CORE Kidney Health Program, Los Angeles, California, United States
- Sim, Zachary C., CORE Kidney Health Program, Los Angeles, California, United States
- Bermudez, Maria Camila, Geisinger Medical Center, Danville, Pennsylvania, United States
- Rastogi, Anjay, CORE Kidney Health Program, Los Angeles, California, United States
Group or Team Name
- Bruin Beans Health Cub
Introduction
Secondary hyperparathyroidism is a common complication of end-stage renal disease (ESRD), typically managed with calcimimetics such as cinacalcet. Refractory cases may require parathyroidectomy, which can be complicated by hungry bone syndrome (HBS) and severe electrolyte disturbances.
Case Description
A 30-year-old female with ESRD secondary to recurrent urinary obstruction and infections following a pelvic injury in infancy underwent multiple reconstructive surgeries, including urethroplasty, colostomy, neovagina creation, and bladder augmentation (Mitrofanoff). Despite slowed CKD progression, she developed hydronephrosis and recurrent tubo-ovarian abscesses, progressing to ESRD in 2013. She was maintained on home hemodialysis five times weekly.
She developed refractory secondary hyperparathyroidism with persistently elevated PTH despite cinacalcet 160 mg daily. Imaging revealed enlarged parathyroid glands, and she underwent subtotal parathyroidectomy. Pathology confirmed hyperplasia.
Postoperatively, she developed HBS with hypocalcemia, hypophosphatemia, and hypomagnesemia. Management included calcium carbonate (1000 mg Q6H), calcitriol (1.25 mcg BID), and high-calcium dialysate baths. Ionized calcium improved from 0.82 to 1.06 within nine days. She also required midodrine for hypotension, likely due to hypocalcemia-induced decreased cardiac contractility and vasodilation. Due to severe calcium depletion, her dialysis regimen was transitioned from home hemodialysis (NxStage) to in-center hemodialysis with high-calcium baths.
Discussion
This case highlights the management challenges of refractory secondary hyperparathyroidism and post-parathyroidectomy complications in ESRD. HBS reflects rapid skeletal calcium uptake following abrupt PTH reduction and requires aggressive supplementation and dialysis modification. The patient’s hypotension underscores the systemic effects of hypocalcemia. Transitioning dialysis modalities further illustrates the complexity of care. Close coordination between nephrology and dialysis teams was essential to manage severe electrolyte disturbances and optimize outcomes.