In:
Internal Medicine Journal, Wiley, Vol. 49, No. 7 ( 2019-07), p. 886-893
Abstract:
Hungry bone syndrome (HBS) is one of the most serious complications following parathyroidectomy for severe hyperparathyroidism. There is a lack of literature informing the treatment and risk factors for this condition and the ideal pre‐operative strategy for prevention. Aims The primary aims were to examine the incidence of HBS with pre‐operative calcitriol loading for 10 days and to determine the risk factors for HBS. The secondary aims were to determine the rate of intravenous calcium replacement in those with HBS and to assess whether cinacalcet removal has increased rates of parathyroidectomy in the end‐stage kidney disease population. Methods We performed a retrospective study from 2011 to 2018 on 45 patients with end‐stage kidney disease undergoing total parathyroidectomy with autotransplantation for severe hyperparathyroidism. This was based at the John Hunter and Newcastle Private Hospitals in New South Wales. Results 28.3% of patients with calcitriol loading undergoing parathyroidectomy fulfilled criteria for HBS. Pre‐operative variables that were associated with HBS were elevated parathyroid hormone ( P = 0.028) and longer duration of renal replacement therapy ( P = 0.033). Rates of total parathyroidectomy were higher after the removal of calcimimetics from the Pharmaceutical Benefits Scheme ( P = 0.0024). Conclusions HBS remains a common complication of parathyroidectomy, even with prolonged high‐dose calcitriol loading. This emphasises the need for further trials investigating other targeted therapies, such as bisphosphonates, to prevent HBS. Those most at risk of HBS are patients with high bone turnover and prolonged renal replacement therapy.
Type of Medium:
Online Resource
ISSN:
1444-0903
,
1445-5994
DOI:
10.1111/imj.2019.49.issue-7
Language:
English
Publisher:
Wiley
Publication Date:
2019
detail.hit.zdb_id:
2044081-9
