Denosumab Use For Severe Hypercalcemia In A Man With End-Stage Renal Disease On Hemodialysis

ABSTRACT Objective: To present a case of severe hypercalcemia in a patient with end-stage renal disease (ESRD) on hemodialysis (HD) unresponsive to conventional hypercalcemia therapies but subsequently responsive to treatment with denosumab. Methods: The clinical, laboratory, and radiologic findings of the case are presented. This is accompanied by a brief literature review. Results: An 81-year-old man with ESRD on HD presented to the hospital with severe symptomatic hypercalcemia that did not respond to hydration, dialysis with low calcium baths, or low dose pamidronate. We administered 60 mg subcutaneous denosumab resulting in a remarkable clinical response, in addition to a subsequent biochemical improvement in serum calcium levels. Conclusion: This is the first case to show that denosumab use results in both clinical and biochemical improvement in an ESRD patient on HD with severe hypercalcemia. Denosumab may be a promising addition to the armamentarium of therapies for severe hypercalcemia in ESRD patients on HD where management has historically been limited by renal status. Abbreviations: ESRD = end-stage renal disease; HD = hemodialysis; iCa = ionized calcium; IV = intravenous; IVF = intravenous fluid; PTH = parathyroid hormone