A Novel Risk Score to Predict Hungry Bone Syndrome After Parathyroidectomy for Renal Hyperparathyroidism

Area of Science:

• Nephrology
• Endocrinology
• Surgical Oncology

Background:

• Hungry bone syndrome (HBS) is a recognized complication following parathyroidectomy, particularly in patients with renal hyperparathyroidism.
• These patients face heightened vulnerability due to prolonged exposure to hormonal and electrolyte imbalances.

Purpose of the Study:

• To characterize predictive factors for HBS in patients with renal hyperparathyroidism undergoing parathyroidectomy.
• To develop a clinical scoring system for identifying patients at high risk of HBS.

Main Methods:

• Retrospective analysis of 33 patients with renal hyperparathyroidism who underwent parathyroidectomy between 2011 and 2021.
• Boruta and binary logistic regression analyses were employed to identify significant predictors and develop a scoring system.

Main Results:

• Nearly half (48%) of the patients developed HBS.
• Preoperative elevated serum parathyroid hormone (PTH) and alkaline phosphatase (ALP) were significantly associated with HBS development.
• A two-point scoring system using elevated ALP (>150 U/L) and markedly elevated PTH (>1000 pg/mL) demonstrated high diagnostic accuracy (96.8%) for predicting HBS.

Conclusions:

• Preoperative serum PTH and ALP levels are significant predictors of HBS in patients with renal hyperparathyroidism undergoing parathyroidectomy.
• A simple scoring system incorporating these two biochemical markers can effectively identify patients at high risk for HBS, aiding in proactive management.