Comparison between the Different Doses of Preoperative Calcitriol to Prevent Hungry Bone Syndrome after Parathyroidectomy in ESKD: A Randomized Controlled Clinical Trial

Background: The most common complication of parathyroidectomy in end-stage kidney disease (ESKD) is hungry bone syndrome (HBS), resulting in prolonged hospitalization. Administering calcitriol before surgery is one strategy for preventing these complications; however, limited studies on the recommended calcitriol dose. The study aims to compare the efficacy and safety of different doses of calcitriol in preventing hypocalcemia in end-stage kidney disease (ESKD). Methods: ESKD patients on regular hemodialysis with renal hyperparathyroidism undergoing parathyroidectomy were randomly assigned to receive 4 mcg/day of calcitriol or 2 mcg/day for 3 days before surgery. The primary outcome was hungry bone syndrome, defined as severe hypocalcemia or hypocalcemia on day 7, and secondary outcomes included electrolyte disturbances and hospitalization length. Results: 28 ESKD patients who underwent parathyroidectomy were enrolled, 14 received 4 mcg and the other 14 received 2 mcg of calcitriol. The mean age was 47.11±11.47 years, the mean serum calcium was 10.56±0.78 mg/dL, and the mean serum parathyroid hormone was 1866±677.62 pg/mL. The incidence of HBS was 62.5%, occurring in 5 (38.5%) and 10 (90.1%) participants in the high and low calcitriol groups, respectively (p = 0.008). The incidence of severe hypocalcemia within 72 hours were 5 (35.7%) in high-dose and 7 (50%) in low-dose groups, respectively (p = 0.704). Other factors including hypophosphatemia and length of hospitalization were similar in both groups. No serious adverse events were reported. Conclusion: 4 mcg of calcitriol showed significant benefits in preventing hungry bone syndrome after parathyroidectomy compared to 2 mcg of calcitriol, without serious adverse effects.