Kritmetapak Kittrawee, Kongpetch Sawinee, Chotmongkol Wijittra, Raruenrom Yutapong, Sangkhamanon Sakkarn, Pongchaiyakul Chatlert
Division of Nephrology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Kidney Center of Excellence, Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand.
Ren Fail. 2020 Nov;42(1):1118-1126. doi: 10.1080/0886022X.2020.1841655.
Hungry bone syndrome (HBS) following parathyroidectomy is associated with severe hypocalcemia and increased morbidity. This study aims to determine the incidence and risk factors of post-parathyroidectomy HBS in dialysis patients with secondary hyperparathyroidism (SHPT).
A retrospective cohort study was conducted, and medical records of patients with SHPT requiring parathyroidectomy between January 2014 and January 2020 were reviewed. HBS was defined as the requirement of intravenous calcium administration due to hypocalcemia-related symptoms and/or reductions in serum calcium concentration (<8.4 mg/dL) within 72 h after parathyroidectomy.
A total of 130 dialysis patients were enrolled. The majority of patients (85.4%) received hemodialysis and the remaining patients (14.6%) received peritoneal dialysis. Ectopic parathyroid glands were identified in 6.6% of patients by preoperative parathyroid scintigraphy. Diffuse parathyroid hyperplasia was the most common histopathological characteristic of SHPT (90.8%). HBS occurred in 82.3% of patients following parathyroidectomy. Preoperative serum intact parathyroid hormone (iPTH) concentration was significantly correlated with serum calcium ( = -0.48, < 0.01) and alkaline phosphatase (ALP) concentration ( = 0.71, < 0.01). Patients with HBS had significantly longer hospital stays than patients without (8 versus 3 days, < 0.01). Based on multiple logistic regression analysis, young age (≤45 years), high preoperative serum ALP (>420 IU/L) and iPTH (>1,000 pg/mL), and absence of preoperative hypercalcemia (>10.2 mg/dL) were significantly associated with HBS.
Post-parathyroidectomy HBS is common in dialysis patients with SHPT. Young age, high preoperative serum ALP and iPTH, and low preoperative serum calcium concentrations were important risk factors for HBS.
甲状旁腺切除术后的饥饿骨综合征（HBS）与严重低钙血症及发病率增加相关。本研究旨在确定继发性甲状旁腺功能亢进（SHPT）透析患者甲状旁腺切除术后HBS的发生率及危险因素。
进行一项回顾性队列研究，回顾了2014年1月至2020年1月期间需要进行甲状旁腺切除术的SHPT患者的病历。HBS定义为甲状旁腺切除术后72小时内由于低钙血症相关症状和/或血清钙浓度降低（<8.4mg/dL）而需要静脉补钙。
共纳入130例透析患者。大多数患者（85.4%）接受血液透析，其余患者（14.6%）接受腹膜透析。术前甲状旁腺闪烁显像在6.6%的患者中发现异位甲状旁腺。弥漫性甲状旁腺增生是SHPT最常见的组织病理学特征（90.8%）。甲状旁腺切除术后82.3%的患者发生HBS。术前血清完整甲状旁腺激素（iPTH）浓度与血清钙（r = -0.48，P < 0.01）和碱性磷酸酶（ALP）浓度（r = 0.71，P < 0.01）显著相关。发生HBS的患者住院时间明显长于未发生HBS的患者（8天对3天，P < 0.01）。基于多因素逻辑回归分析，年轻（≤45岁）、术前血清ALP水平高（>420IU/L）和iPTH水平高（>1000pg/mL）以及术前无高钙血症（>10.2mg/dL）与HBS显著相关。
甲状旁腺切除术后HBS在SHPT透析患者中很常见。年轻、术前血清ALP和iPTH水平高以及术前血清钙浓度低是HBS的重要危险因素。
