ArticleInternational urology and nephrology2020
Hungry bone syndrome after parathyroidectomy in end-stage renal disease patients: review of an alkaline phosphatase-based treatment protocol.
Article in International urology and nephrology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers.
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15 citing papers in PubMed, 20 citations in OpenAlex.
- Bone turnover markers in the management of CKD-associated osteoporosis-a European consensus.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2026Review
- Predicting Hungry Bone Syndrome with Interpretable Machine Learning: A Single-Center Cohort of Dialysis Patients Undergoing Parathyroidectomy.Diagnostics (Basel, Switzerland) · 2026Article
- Predictors of Hungry Bone Syndrome After Parathyroidectomy in Secondary Hyperparathyroidism: A Narrative Review of Bone Turnover Biomarkers and Risk Prediction Tools.Journal of clinical medicine · 2025Review
- Predictors of Hypocalcemia Post Parathyroidectomy for Primary Hyperparathyroidism; a Single Center Study.Endocrinology, diabetes & metabolism · 2025Article
- Determinants of Severe Hypocalcemia After Parathyroidectomy in Patients with End-Stage Kidney Disease and Renal Hyperparathyroidism: A Retrospective Cohort Study.Journal of clinical medicine · 2025Article
- Efficacy and safety of prophylactic intravenous calcium supplementation in patients with secondary hyperparathyroidism after parathyroidectomy: a retrospective study.Frontiers in endocrinology · 2025Article
- Multidisciplinary team approach for CKD-associated osteoporosis.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2024Article
- A nomogram prediction model for hungry bone syndrome in dialysis patients with secondary hyperparathyroidism after total parathyroidectomy.European journal of medical research · 2024Article
- Hungry bone syndrome in peritoneal dialysis patients after parathyroid surgery.Endocrine connections · 2023Article
- Forestalling Hungry Bone Syndrome after Parathyroidectomy in Patients with Primary and Renal Hyperparathyroidism.Diagnostics (Basel, Switzerland) · 2023Review
- A reappraisal of risk factors for early hypocalcemia after parathyroidectomy in dialysis patients.Updates in surgery · 2022Article
- Data to inform counseling on parathyroidectomy for secondary hyperparathyroidism of renal origin.Surgery · 2022Article
- Advances in the treatment of secondary and tertiary hyperparathyroidism.Frontiers in endocrinology · 2022Review
- Factors influencing the development of bone starvation syndrome after total parathyroidectomy in patients with renal hyperparathyroidism.Frontiers in surgery · 2022Article
- Risk Factors for Severe Hypocalcemia in Patients with Secondary Hyperparathyroidism after Total Parathyroidectomy.International journal of endocrinology · 2021Article
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Authors and funding
5 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
aimHyperparathyroidism in chronic kidney disease-mineral and bone disorder is associated with significant morbidity and mortality. Parathyroidectomy is widely carried out as treatment despite complications such as hypocalcaemia post-surgery. Our centre has been using an ALP-based protocol to replace calcium postoperatively to prevent hypocalcaemia. We aim to describe and audit our calcium replacement protocol post-parathyroidectomy
methodsWe, retrospectively, analyse 167 end-stage kidney disease patients who had parathyroidectomy with auto-implantation in Singapore General Hospital between January 2008 and December 2013. Their calcium replacement postoperatively was initiated upon patient arrival back in ward on the same day of surgery based on their pre-op ALP prior to occurrence of hypocalcaemia. Patient demographics, surgical and laboratory parameters were reviewed from medical records. Changes in calcium postoperatively were reported to look for incidence of calcium derangement.
resultsMean calcium levels between pre-operation day and post-operation day 7 ranged from 2.31 to 2.70 mmol/L. Decline in serum calcium was common in all patients prior to starting calcium replacement. Eighteen patients (10.9%) experienced hypocalcaemia immediately post-operation prior to commencement of IV calcium replacement. Patients with immediate post-operation hypocalcaemia had lower pre-operation calcium but higher pre-operation alkaline phosphatase (ALP) and pre-operation intact parathyroid hormone. Hypercalcaemia is common likely from aggressive IV calcium replacement using the protocol. The average length of stay for patients prior to calcium stabilization and discharge was 9 days.
conclusionImplementation of an ALP-based prophylactic calcium replacement protocol with daily serum calcium monitoring can ameliorate severe hypocalcaemia post-parathyroidectomy.
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