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Calcium supplementation after parathyroidectomy in dialysis and renal transplant patients

Authors Florescu M, Islam K, Plumb T, Smith-Shull S, Nieman J, Mandalapu P

Received 2 November 2013

Accepted for publication 9 December 2013

Published 14 May 2014 Volume 2014:7 Pages 183—190


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 5

Marius C Florescu,1 KM Monirul Islam,2 Troy J Plumb,1 Sara Smith-Shull,3 Jennifer Nieman,3 Prasanti Mandalapu1

1Nephrology Department, 2Institute of Public Health, 3Department of Pharmacy, The Nebraska Medical Center, Omaha, NE, USA

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).
Conclusion: 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.

Keywords: parathyroidectomy, hungry bone syndrome, hypocalcemia

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