Analysis of factors affecting hungry bone syndrome after total parathyroidectomy in patients with hyper-parathyroidism secondary to chronic kidney disease

QI Yonghui; LIN Yanyu; WU Huiying; XIONG Xingyu; CHEN Ruman; ZHU Yongjun

doi:10.3969/j.issn.1002-266X.2024.32.005

Abstract：Objective To analyze the factors influencing hungry bone syndrome(HBS)after total parathyroid resec-tion(tPTX)in patients with chronic kidney disease complicated with refractory secondary hyperparathyroidism(rSHPT)undergoing maintenance hemodialysis.Methods Totally 116 chronic kidney disease patients with rSHPT undergoing tP-TX were included.The occurrence of HBS was observed and patients were divided into HBS and non-HBS groups.We compared the clinical data of the two groups,and the items with statistically significant differences in univariate analysis were included in the Logistic regression to analyze the independent influencing factors,and multiple linear regression was used to analyze the influencing factors of intravenous calcium supplementation duration and total calcium supplementation in the HBS group.Results After parathyroidectomy,88 patients(75.86%)had HBS(HBS group)and 28 patients did not have HBS(non-HBS group).The proportion of men,length of intravenous calcium supplementation,total calcium supplementation,total preoperative parathyroid hormone(iPTH),alkaline phosphatase(ALP)levels before and after sur-gery in the HBS group were higher,and age,hemoglobin at 1 week after surgery,and corrected blood calcium levels be-fore and after surgery were lower than those of the non-HBS group(all P<0.05).The results of Logistic regression analysis showed that age,preoperative corrected blood calcium,and 1-week postoperative ALP were independent influencing fac-tors for HBS after tPTX in patients with rSHPT(all P<0.05).The results of multiple linear regression analysis showed that age,preoperative iPTH,postoperative 4 h corrected blood calcium,and postoperative blood phosphorus were independent influencing factors for the total calcium supplementation in HBS group(all P<0.05);age,preoperative iPTH,postopera-tive 4 h corrected blood calcium,and ALP ratio were independent influencing factors for the length of intravenous calcium supplementation in HBS group(all P<0.05).Conclusions Age,preoperative blood calcium,and postoperative ALP level were the influencing factors of HBS after tPTX in patients with chronic kidney disease and rSHPT.The postoperative calcium supplementation was greater in patients with young age,low blood calcium at 4 h after surgery,and high preopera-tive iPTH.