Hungry bone syndrome (HBS) is a common complication following renal parathyroidectomy and associated with increased mortality. In this study we evaluate the incidence of HBS in patients who underwent surgery for renal hyperparathyroidism.

Retrospective cohort review of patients who underwent parathyroidectomy between 2000-2022 were reviewed. HBS was defined as hypocalcaemia (serum calcium < 2.1mmol/L) associated with symptoms requiring intravenous calcium replacement within 72 hours post-parathyroidectomy. Alkaline phosphatase-based calcium replacement protocol was instituted in 2014 and the cohort divided into 2 groups (pre-2014 and post-2014) Univariate and multivariate analysis for factors predictive of HBS was performed.

268 patients (148F:120M) with a mean age of 57years underwent parathyroidectomy during the study period. 118 of 268 (44%) underwent surgery after 2014 and 150 of 268 (56%) prior to 2014. The mean pre-excision biochemical indices at index surgery were the following: PTH (258.6pmol/L), corrected serum calcium (2.65mmol/L), serum phosphorus (1.98mmol/L) and serum alkaline phosphatase (353U/L). 15 of 268 (6%) patients developed HBS in the whole cohort and of these 14 of 15 (93%) developed HBS before 2014 (p=0.01). The median stay was 10 days for patients with HBS compared to 5 days for patients with no HBS (p=0.02). HBS was associated with lower median PTH, lower corrected serum calcium (2.1 vs 2.48) and higher ALP levels (277 vs 343). Cohort mortality was 77 of 268 (29%) and was higher in HBS group (60 vs 27%).

The incidence of HBS significantly reduced after introduction of ALP based protocol to reduce hypocalcaemia.