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Tai YL, Shen HY, Nai WH, Fu JF, Wang IK, Huang CC, Weng CH, Lee CC, Huang WH, Yang HY, Hsu CW, Yen TH. Hungry bone syndrome after parathyroid surgery. Hemodial Int 2023; 27:134-145. [PMID: 36719854 DOI: 10.1111/hdi.13067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 11/06/2022] [Accepted: 01/10/2023] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Data on the incidence rates of hungry bone syndrome after parathyroidectomy in patients on dialysis are inconsistent, as the published rates vary from 15.8% to 92.9%. METHODS Between 2009 and 2019, 120 hemodialysis patients underwent parathyroidectomy for secondary hyperparathyroidism at the Chang Gung Memorial Hospital. The patients were stratified into two groups based on the presence (n = 100) or absence (n = 20) of hungry bone syndrome after parathyroidectomy. FINDINGS Subtotal parathyroidectomy was the most common surgery performed (76.7%), followed by total parathyroidectomy with autoimplantation (23.3%). Pathological examination revealed parathyroid hyperplasia. Hungry bone syndrome developed within 0.3 ± 0.3 months and lasted for 11.1 ± 14.7 months. After surgery, compared with patients without hungry bone syndrome, patients with hungry bone syndrome had lower levels of nadir corrected calcium (P < 0.001), as well as lower nadir (P < 0.001) and peak (P < 0.001) intact parathyroid hormone levels. During 59.3 ± 44.0 months of follow-up, persistence and recurrence of hyperparathyroidism occurred in 25 (20.8%) and 30 (25.0%) patients, respectively. Furthermore, patients with hungry bone syndrome had a lower rate of persistent hyperparathyroidism than those without hungry bone syndrome (P < 0.001). Four patients (3.3%) underwent a second parathyroidectomy. Patients with hungry bone syndrome received fewer second parathyroidectomies than those without hungry bone syndrome (P < 0.001). Finally, a multivariate logistic regression model revealed that the preoperative blood ferritin level was a negative predictor of the development of hungry bone syndrome (P = 0.038). DISCUSSION Hungry bone syndrome is common (83.3%) after parathyroidectomy for secondary hyperparathyroidism in patients undergoing hemodialysis, and this complication should be monitored and managed appropriately.
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Affiliation(s)
- Ya-Ling Tai
- Department of Nephrology, Clinical Poison Center, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsin-Yi Shen
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Hsuan Nai
- Department of Nephrology, Clinical Poison Center, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jen-Fen Fu
- Department of Medical Research, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - I-Kuan Wang
- Department of Nephrology, China Medical University Hospital, Taichung and College of Medicine, China Medical University, Taichung, Taiwan
| | - Chien-Chang Huang
- Department of Nephrology, Clinical Poison Center, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Hao Weng
- Department of Nephrology, Clinical Poison Center, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Chia Lee
- Department of Nephrology, Clinical Poison Center, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wen-Hung Huang
- Department of Nephrology, Clinical Poison Center, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Huang-Yu Yang
- Department of Nephrology, Clinical Poison Center, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Wei Hsu
- Department of Nephrology, Clinical Poison Center, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tzung-Hai Yen
- Department of Nephrology, Clinical Poison Center, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Ultrasound Renal Score to Predict the Renal Disease Prognosis in Patients with Diabetic Kidney Disease: An Investigative Study. Diagnostics (Basel) 2023; 13:diagnostics13030515. [PMID: 36766619 PMCID: PMC9913982 DOI: 10.3390/diagnostics13030515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/15/2023] [Accepted: 01/26/2023] [Indexed: 02/01/2023] Open
Abstract
Renal disease associated with type 2 diabetes mellitus (T2DM) has become the leading cause of chronic kidney disease (CKD). Renal ultrasonography is an imaging examination required in the work-up of renal disease. This study aimed to identify the differences in renal ultrasonographic findings between patients with and without DM, and to evaluate the relationship between renal ultrasound findings and renal prognosis in patients with DM. A total of 252 patients who underwent renal ultrasonography at Chungnam National University Hospital were included. Kidney disease progression was defined as a ≥10% decline in the annual estimated glomerular filtration rate (eGFR), which, in this paper, is referred to as ΔeGFR/year, or the initiation of renal replacement therapy after follow-up. The renal scoring system was evaluated by summing up the following items: the value of renal parenchymal echogenicity (0: normal; 1: mildly increased; and 2: increased) and the shape of the cortical margin (0: normal and 1: irregular; right kidney length/height (RH-0 or 1), mean cortical thickness/renal length/height (CKH-0 or 1), and cortical thickness/parenchymal thickness (CK/PK-0 or 1) based on the median: 0-above median, and 1-below median). Patients with DM had thicker renal PKH than those without, despite having lower eGFRs (0.91 ± 0.15, 0.86 ± 0.14, p = 0.006). In the progression group, the renal scores were significantly higher than those from the non-progression group. In the multivariate logistic regression analysis, the higher renal scores, presence of DM, and younger age were independently predicted for renal disease progression after adjusting for confounding variables, such as the presence of hypertension, serum hemoglobin and albumin levels, and UPCR. In conclusion, patients with high renal scores were significantly associated with renal disease progression. Our results suggest that renal ultrasonography at the time of diagnosis provides useful prognostic information in patients with kidney disease.
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Wang M, Hsu HC, Yu MC, Wang IK, Huang CC, Chan M, Weng CH, Huang WH, Hsu CW, Huang LM, Tam FWK, Yen TH. Impact of kidney size on the outcome of diabetic patients receiving hemodialysis. PLoS One 2022; 17:e0266231. [PMID: 35358262 PMCID: PMC8970390 DOI: 10.1371/journal.pone.0266231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 03/16/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction
Diabetic patients normally have enlarged or normal-sized kidneys throughout their lifetime, but some diabetic uremic patients have small kidneys. It is uncertain if kidney size could have any negative impact on outcome in hemodialysis patients.
Methods
This longitudinal, observational cohort study recruited 301 diabetic hemodialysis patients in 2015, and followed until 2019. Patients were stratified into two subgroups according to their kidney sizes before dialysis, as small (n = 32) or enlarged or normal (n = 269). Baseline demographic, hematological, biochemical, nutritional, inflammatory and dialysis related data were collected for analysis.
Results
Patients with small kidney size were not only older (P<0.001) and had lower body mass index (P = 0.016), but had also higher blood uric acid concentration (P<0.001) compared with patients with enlarged or normal kidney size. All patients received adequate doses of hemodialysis since the Kt/V and urea reduction ratio was 1.7±0.3 and 0.7±0.1, respectively. Patients with small size kidneys received higher erythropoietin dose than patients with enlarged or normal kidney size (P = 0.031). At the end of analysis, 92 (30.6%) patients expired. Kaplan-Meier analysis revealed no survival difference between both groups (P = 0.753). In a multivariate logistic regression model, it was demonstrated that age (P<0.001), dialysis duration (P<0.001), as well as blood albumin (P = 0.012) and low-density lipoprotein (P = 0.009) concentrations were significantly correlated with mortality.
Conclusions
Small kidney size on starting hemodialysis was not related with an augmented risk for death in diabetic patients receiving hemodialysis. Further studies are necessary.
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Affiliation(s)
- Min Wang
- Department of Nephrology, Clinical Poison Center, Kidney Research Center, Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, and Chang Gung University, Taoyuan, Taiwan
| | - Hsin-Chiao Hsu
- Department of Nephrology, Clinical Poison Center, Kidney Research Center, Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, and Chang Gung University, Taoyuan, Taiwan
| | - Mei-Ching Yu
- Division of Pediatric Nephrology, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou, and Chang Gung University, Taoyuan, Taiwan
| | - I-Kuan Wang
- Department of Nephrology, China Medical University Hospital, Taichung, and China Medical University, Taichung, Taiwan
| | - Chien-Chang Huang
- Department of Nephrology, Clinical Poison Center, Kidney Research Center, Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, and Chang Gung University, Taoyuan, Taiwan
| | - Ming‐Jen Chan
- Department of Nephrology, Clinical Poison Center, Kidney Research Center, Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, and Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Hao Weng
- Department of Nephrology, Clinical Poison Center, Kidney Research Center, Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, and Chang Gung University, Taoyuan, Taiwan
| | - Wen-Hung Huang
- Department of Nephrology, Clinical Poison Center, Kidney Research Center, Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, and Chang Gung University, Taoyuan, Taiwan
| | - Ching-Wei Hsu
- Department of Nephrology, Clinical Poison Center, Kidney Research Center, Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, and Chang Gung University, Taoyuan, Taiwan
| | - Lan-Mei Huang
- Department of Nephrology, Clinical Poison Center, Kidney Research Center, Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, and Chang Gung University, Taoyuan, Taiwan
| | - Frederick W. K. Tam
- Department of Immunology and Inflammation, Centre for Inflammatory Disease, Imperial College London, London, United Kingdom
| | - Tzung-Hai Yen
- Department of Nephrology, Clinical Poison Center, Kidney Research Center, Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, and Chang Gung University, Taoyuan, Taiwan
- * E-mail:
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Chuang PH, Tsai KF, Wang IK, Huang YC, Huang LM, Liu SH, Weng CH, Huang WH, Hsu CW, Lee WC, Yen TH. Blood Aluminum Levels in Patients with Hemodialysis and Peritoneal Dialysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3885. [PMID: 35409569 PMCID: PMC8997989 DOI: 10.3390/ijerph19073885] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/18/2022] [Accepted: 03/22/2022] [Indexed: 02/04/2023]
Abstract
Background. This retrospective observational study attempted to examine the prevalence of abnormal blood aluminum levels in dialysis patients, and to explore the association of pathogenic factors, such as demographic, clinical, laboratory as well as the use of phosphate binding drugs, drugs for secondary hyperparathyroidism and erythropoiesis-stimulating drugs with the blood aluminum levels. Methods. The study included 1175 patients (874 hemodialysis and 301 peritoneal dialysis), recruited from Chang Gung Memorial Hospital in November 2020. Patients were stratified into two groups by their blood aluminum levels, as normal (<2 µg/dL, n = 1150) or abnormal (≥2 µg/dL, n = 25). Results. The patients aged 60.4 ± 13.2 years and were dialyzed for 8.6 ± 8.1 years. The average blood aluminum level was 1.0 ± 0.4 µg/dL. Patients with abnormal blood aluminum levels received more sevelamer than patients with normal blood aluminum level (p = 0.014). Patients with abnormal blood aluminum levels had higher platelet count (p = 0.001), triglyceride (p < 0.001) and total iron binding capacity (p = 0.003) than patients with normal blood aluminum levels. Moreover, the cardiothoracic ratio was higher in patients with abnormal blood aluminum levels than patients with normal blood aluminum levels (p = 0.003). Conclusions. The prevalence of abnormal blood aluminum levels was low at 2.2%. Nevertheless, the linking of cardiothoracic ratio of more than 0.5 as well as elevated blood platelet count and triglyceride level with blood aluminum levels are interesting, and warranted more researches in this area.
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Affiliation(s)
- Po-Hsun Chuang
- Department of Nephrology, Clinical Poison Center, Chang Gung Memorial Hospital, Linkou 333, Taiwan; (P.-H.C.); (L.-M.H.); (S.-H.L.); (C.-H.W.); (W.-H.H.); (C.-W.H.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (K.-F.T.); (Y.-C.H.); (W.-C.L.)
| | - Kai-Fan Tsai
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (K.-F.T.); (Y.-C.H.); (W.-C.L.)
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - I-Kuan Wang
- Department of Nephrology, China Medical University Hospital, Taichung 404, Taiwan;
- College of Medicine, China Medical University, Taichung 406, Taiwan
| | - Ya-Ching Huang
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (K.-F.T.); (Y.-C.H.); (W.-C.L.)
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Linkou 333, Taiwan
| | - Lan-Mei Huang
- Department of Nephrology, Clinical Poison Center, Chang Gung Memorial Hospital, Linkou 333, Taiwan; (P.-H.C.); (L.-M.H.); (S.-H.L.); (C.-H.W.); (W.-H.H.); (C.-W.H.)
| | - Shou-Hsuan Liu
- Department of Nephrology, Clinical Poison Center, Chang Gung Memorial Hospital, Linkou 333, Taiwan; (P.-H.C.); (L.-M.H.); (S.-H.L.); (C.-H.W.); (W.-H.H.); (C.-W.H.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (K.-F.T.); (Y.-C.H.); (W.-C.L.)
| | - Cheng-Hao Weng
- Department of Nephrology, Clinical Poison Center, Chang Gung Memorial Hospital, Linkou 333, Taiwan; (P.-H.C.); (L.-M.H.); (S.-H.L.); (C.-H.W.); (W.-H.H.); (C.-W.H.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (K.-F.T.); (Y.-C.H.); (W.-C.L.)
| | - Wen-Hung Huang
- Department of Nephrology, Clinical Poison Center, Chang Gung Memorial Hospital, Linkou 333, Taiwan; (P.-H.C.); (L.-M.H.); (S.-H.L.); (C.-H.W.); (W.-H.H.); (C.-W.H.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (K.-F.T.); (Y.-C.H.); (W.-C.L.)
| | - Ching-Wei Hsu
- Department of Nephrology, Clinical Poison Center, Chang Gung Memorial Hospital, Linkou 333, Taiwan; (P.-H.C.); (L.-M.H.); (S.-H.L.); (C.-H.W.); (W.-H.H.); (C.-W.H.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (K.-F.T.); (Y.-C.H.); (W.-C.L.)
| | - Wen-Chin Lee
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (K.-F.T.); (Y.-C.H.); (W.-C.L.)
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Tzung-Hai Yen
- Department of Nephrology, Clinical Poison Center, Chang Gung Memorial Hospital, Linkou 333, Taiwan; (P.-H.C.); (L.-M.H.); (S.-H.L.); (C.-H.W.); (W.-H.H.); (C.-W.H.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (K.-F.T.); (Y.-C.H.); (W.-C.L.)
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