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Peritoneal dialysis can alleviate the clinical course of hungry bone syndrome after parathyroidectomy in dialysis patients with secondary hyperparathyroidism

  • Guang Yang
  • Yifei Ge
  • Xiaoming Zha
  • Huijuan Mao
  • Ningning Wang
  • Changying XingEmail author
Nephrology - Original Paper
  • 16 Downloads

Abstract

Purpose

It is unclear whether clinical courses of hungry bone syndrome (HBS) after parathyroidectomy (PTX) in peritoneal dialysis (PD) and hemodialysis (HD) patients are different. The present study aimed to investigate the possible differences of postoperative hypocalcemia and hyperkalemia between PD and HD patients.

Methods

We performed retrospectively 29 PD patients as the PD group and 169 HD patients as the HD group undergoing successful total PTX with autotransplantation. Calcium supplement after surgery was recorded. Higher levels of serum potassium during and immediately after surgery were recorded as K+d0. K+d3 was recorded as peak pre-dialysis serum potassium level 3 days post-surgery.

Results

There were 157 (92.90%) patients in HD group and 22 (75.86%) patients in PD group suffered from HBS after surgery, with significant difference between the groups (P = 0.004). Patients in PD group had significantly shorter intravenous calcium supplement duration (P = 0.037) and significantly smaller intravenous calcium supplement dosage (P = 0.042) and total calcium supplement dosage during hospitalization (P = 0.012) than patients in HD group. The levels of serum K+d0 (P < 0.001) and K+d3 (P < 0.001) were both significantly lower in PD group than those in HD group. Peritoneal dialysis was one of the independent influencing factors with negative correlation for calcium supplement, serum K+d0 and serum K+d3.

Conclusions

Compared with HD patients, the clinical course of HBS after PTX in PD patients was alleviated. Efforts should be devoted to individual perioperative management for PD patients undergoing PTX.

Keywords

Peritoneal dialysis Hemodialysis Hyperkalemia Hypocalcemia Secondary hyperparathyroidism Parathyroidectomy 

Notes

Acknowledgements

This work was supported by the Clinical Medical Technology Special Incentive Fund of Jiangsu Province (BL2014080).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the First Affiliated Hospital of Nanjing Medical University Ethics Committee. All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

References

  1. 1.
    Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Update Work Group (2017) KDIGO 2017 clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease–mineral and bone disorder (CKD-MBD). Kidney Int Suppl 7:1–59CrossRefGoogle Scholar
  2. 2.
    Brasier AR, Nussbaum SR (1988) Hungry bone syndrome: clinical and biochemical predictors of its occurrence after parathyroid surgery. Am J Med 84:654–660CrossRefGoogle Scholar
  3. 3.
    Ho LY, Wong PN, Sin HK et al (2017) Risk factors and clinical course of hungry bone syndrome after total parathyroidectomy in dialysis patients with secondary hyperparathyroidism. BMC Nephrol 18(1):12–21CrossRefGoogle Scholar
  4. 4.
    Goldfarb M, Gondek SS, Lim SM et al (2012) Postoperative hungry bone syndrome in patients with secondary hyperparathyroidism of renal origin. World J Surg 36:1314–1319CrossRefGoogle Scholar
  5. 5.
    Latus J, Roesel M, Fritz P et al (2013) Incidence of and risk factors for hungry bone syndrome in 84 patients with secondary hyperparathyroidism. Int J Nephrol Renovasc Dis 8(6):131–137CrossRefGoogle Scholar
  6. 6.
    Florescu MC, Islam KM, Plumb TJ et al (2014) Calcium supplementation after parathyroidectomy in dialysis and renal transplant patients. Int J Nephrol Renovasc Dis 14(7):183–190CrossRefGoogle Scholar
  7. 7.
    Tsai WC, Peng YS, Chiu YL et al (2015) Risk factors for severe hypocalcemia after parathyroidectomy in prevalent dialysis patients with secondary hyperparathyroidism. Int Urol Nephrol 47(7):1203–1207CrossRefGoogle Scholar
  8. 8.
    Hayes JF, Gross GF, Schuman ES (1982) Surgical management of renal hyperparathyroidism in the dialysis patient. Am J Surg 143:569–571CrossRefGoogle Scholar
  9. 9.
    Cruz DN, Perazella MA (1997) Biochemical aberrations in a dialysis patient following parathyroidectomy. Am J Kidney Dis 29:759–762CrossRefGoogle Scholar
  10. 10.
    Bajaj Y, Roberts S, Simon D et al (2011) Intra-operative hyperkalemia: a serious but under recognised complication of renal parathyroidectomy—a prospective study: how we do it. Clin Otolaryngol 36:69–72CrossRefGoogle Scholar
  11. 11.
    Yang YL, Lu HF, Chung KC et al (2015) Young age, male sex, and end-stage renal disease with secondary hyperparathyroidism as risk factors for intraoperative hyperkalemia during parathyroidectomy. J Clin Anesth 27:195–200CrossRefGoogle Scholar
  12. 12.
    Li S, Liu S, Chen Q et al (2018) Clinical predictor of postoperative hyperkalemia after parathyroidectomy in patients with hemodialysis. Int J Surg 53:1–4CrossRefGoogle Scholar
  13. 13.
    Hiramitsu T, Tominaga Y, Okada M et al (2015) A retrospective study of the impact of intraoperative intact parathyroid hormone monitoring during total parathyroidectomy for secondary hyperparathyroidism: STARD study. Medicine 94(29):e1213CrossRefGoogle Scholar
  14. 14.
    Randolph GW (2013) Surgery of the thyroid and parathyroid glands. In: Tominaga Y (ed) Surgical management of secondary and tertialy hyperparathyroidism. Elsevier Saunders, Philadelphia, pp 639–647Google Scholar
  15. 15.
    Jofré R, López Gómez JM et al (2003) Parathyroidectomy: whom and when? Kidney Int Suppl 85:S97–S100CrossRefGoogle Scholar
  16. 16.
    Edwards NC, Steeds RP, Chue CD et al (2012) The safety and tolerability of spironolactone in patients with mild to moderate chronic kidney disease. Br J Clin Pharmacol 73(3):447–454CrossRefGoogle Scholar
  17. 17.
    Navarrete N (2018) Hyperkalemia in electrical burns: a retrospective study in Colombia. Burns 44(4):941–946CrossRefGoogle Scholar
  18. 18.
    Kidney Disease: Improving Global Outcomes C-MWG (2009) KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD). Kidney Int 113:S1–S130Google Scholar
  19. 19.
    Zhang J, Yu X, Sun B et al (2013) Parathyroidectomy and heart rate variability in patients with stage 5 CKD. Clin J Am Soc Nephrol 8(8):1378–1387CrossRefGoogle Scholar
  20. 20.
    Zhang LN, Yang G, Cheng C et al (2015) Plasma FGF23 levels and heart rate variability in patients with stage 5 CKD. Osteoporos Int 26(1):395–405CrossRefGoogle Scholar
  21. 21.
    Yang G, Zhang B, Zha XM et al (2014) Total parathyroidectomy with autotransplantation for a rare disease derived from uremic secondary hyperparathyroidism, the uremic leontiasis ossea. Osteoporos Int 25(3):1115–1121CrossRefGoogle Scholar
  22. 22.
    Fukagawa M, Yokoyama K, Koiwa F, CKD-MBD Guideline Working Group; Japanese Society for Dialysis Therapy et al (2013) Clinical practice guideline for the management of chronic kidney disease-mineral and bone disorder. Ther Apher Dial 17(3):247–288CrossRefGoogle Scholar
  23. 23.
    Jain N, Reilly RF (2017) Hungry bone syndrome. Curr Opin Nephrol Hypertens 26(4):250–255CrossRefGoogle Scholar
  24. 24.
    Ott SM (2008) Histomorphometric measurements of bone turnover, mineralization, and volume. Clin J Am Soc Nephrol 3(Suppl 3):S151–S156CrossRefGoogle Scholar
  25. 25.
    Black DM, Bouxsein ML, Palermo L, PTH Once-Weekly Research (POWR) Group et al (2008) Randomized trial of once-weekly parathyroid hormone (1–84) on bone mineral density and remodeling. J Clin Endocrinol Metab 93(6):2166–2172CrossRefGoogle Scholar
  26. 26.
    Silva I, Branco JC (2011) Rank/Rankl/opg: literature review. Acta Reumatol Port 36(3):209–218Google Scholar
  27. 27.
    Bauer D, Krege J, Lane N et al (2012) National bone health alliance bone turnover marker project: current practices and the need for US harmonization, standardization, and common reference ranges. Osteoporos Int 23(10):2425–2433CrossRefGoogle Scholar
  28. 28.
    Lehmann G, Stein G, Hüller M et al (2005) Specific measurement of PTH (1–84) in various forms of renal osteodystrophy (ROD) as assessed by bone histomorphometry. Kidney Int 68:1206–1214CrossRefGoogle Scholar
  29. 29.
    Noordzij M, Cranenburg EM, Engelsman LF et al (2011) Progression of aortic calcification is associated with disorders of mineral metabolism and mortality in chronic dialysis patients. Nephrol Dial Transplant 26(5):1662–1669CrossRefGoogle Scholar
  30. 30.
    Khan AN, Bernardini J, Johnston JR et al (1996) Hypokalemia in peritoneal dialysis patients. Perit Dial Int 16:652Google Scholar
  31. 31.
    Szeto CC, Chow KM, Kwan BC et al (2005) Hypokalemia in Chinese peritoneal dialysis patients: prevalence and prognostic implication. Am J Kidney Dis 46(1):128–135CrossRefGoogle Scholar
  32. 32.
    Chuang YW, Shu KH, Yu TM et al (2009) Hypokalaemia: an independent risk factor of Enterobacteriaceae peritonitis in CAPD patients. Nephrol Dial Transplant 24:1603–1608CrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  • Guang Yang
    • 1
  • Yifei Ge
    • 1
  • Xiaoming Zha
    • 2
  • Huijuan Mao
    • 1
  • Ningning Wang
    • 1
  • Changying Xing
    • 1
    Email author
  1. 1.Department of NephrologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
  2. 2.Department of General SurgeryThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina

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