Management of hypercalcaemic crisis in adults: Current role of renal replacement therapy

Bentata, Y.; Maghraoui, Hamida; Benabdelhak, M.; Haddiya, I.

doi:10.1016/j.ajem.2018.03.011

Cited by 7 publications

(6 citation statements)

References 9 publications

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“…The reported in-hospital mortality rate of severe hypercalcemia patients who underwent intermittent hemodialysis was 25% [8],which was higher than the average in-hospital mortality rate of our present cohort (15.2%). Additionally, there was a slight reduction in the in-hospital mortality rate in the RCA group.…”

Section: Discussioncontrasting

confidence: 76%

“…Therefore, CVVH could maintain the stability of the serum calcium concentration for a longer term. Calcium-free intermittent hemodialysis could reduced the serum calcium concentration as well [3,8]. However, after the 4 h calcium-free intermittent hemodialysis, the re-distribution of the calcium most likely would cause quickly rebound of the serum calcium level.…”

Section: Discussionmentioning

confidence: 99%

“…Primary hyperparathyroidism and malignancy are the most common causes for hypercalcemia [2,3]. Although severe hypercalcemia ('hypercalcemic crisis') only occurs 1.6-6.7% in hypercalcemia patients, it leads to a 14-fold increase in acute kidney injury (AKI) risk [4,5] and is associated with a mortality that ranges from 15% to 100% [6][7][8][9][10]. Nausea, vomiting, weakness, arrhythmia, and disorientation are the major symptoms of hypercalcemia [1,2].…”

Section: Introductionmentioning

confidence: 99%

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Regional citrate anticoagulation versus low molecular weight heparin anticoagulation for continuous venovenous hemofiltration in patients with severe hypercalcemia: a retrospective cohort study

Bai

Zhang

et al. 2020

Renal Failure

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Purpose: We conducted a retrospective study to evaluate the efficacy and safety of regional citrate anticoagulation (RCA) versus those of low molecular weight heparin (LMWH) anticoagulation for CVVH in severe hypercalcemia patients. Methods: Between January 2014 and May 2019, 33 severe hypercalcemia patients underwent CVVH. Patients were divided into the RCA and LMWH groups. Calcium-free replacement solution was used. Serum total calcium reduction rate (RRSeCa), filter lifespan, bleeding, totCa/ionCa ratio, citrate accumulation, and catheter occlusion were evaluated as outcomes. Results: RCA and LMWH were employed for CVVH in 14 and 43 filters, respectively. RRSeCa was not significantly different between the LMWH and RCA groups (p ¼ .320), but RCA-CVVH was more effective in reducing ionized calcium at half of the time points (p < .05). RCA significantly prolonged the median filter lifespan (>72 h vs. 24.0 h [IQR, 15.0-26.0], p ¼ .012). The incidence of filter failure was 55.8% (24/43) in the LMWH group and 21.4% (3/14) in the RCA group (p ¼ .033). The adjusted results demonstrated that RCA could significantly reduce the risk of filter failure (p ¼ .043, 95% CI 0.059-0.957, HR ¼ 0.238). No citrate accumulation or bleeding episodes were observed in the RCA-CVVH group. Seven bleeding episodes (7/43, 16.3%) occurred in the LMWH-CVVH group. Conclusions: In patients with severe hypercalcemia who underwent CVVH, RCA more effectively decreased calcium levels and had a superior filter lifespan and no obvious adverse events compared with LMWH. Further prospective, randomized, controlled studies are warranted to obtain robust evidence.

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Section: Discussioncontrasting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Regional citrate anticoagulation versus low molecular weight heparin anticoagulation for continuous venovenous hemofiltration in patients with severe hypercalcemia: a retrospective cohort study

Bai

Zhang

et al. 2020

Renal Failure

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“…A recent review of patients requiring haemodiafiltration in a nephrology unit for the treatment of hypercalcaemic crisis, demonstrated only eight cases of acute kidney injury. 5 As described above, our patient had developed a hyperdynamic cardiac state with a palpable thrill, likely contributing to a degree of circulatory overload, increased diastolic pressure and pulmonary oedema. A review by Andersson et al 6 found increasing evidence of pathological LVH in patients with primary hyperparathyroidism.…”

Section: Discussionmentioning

confidence: 66%

A case of multi-organ failure due to hyperparathyroidism-related hypercalcaemia

Cummings

Vannahme

Stanworth

2019

Journal of the Intensive Care Society

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Albeit still rare, hypercalcaemia has been linked to pulmonary oedema in solid organ malignancy and chronic renal failure. However to date, there is only one case report linking pulmonary oedema to hypercalcaemia secondary to primary hyperparathyroidism. Case presentation A 60-year-old male presented to the emergency department with a history of confusion and collapse. Investigations revealed initial serum calcium of over 5 mmol/L. He subsequently developed widespread bilateral chest infiltrates with increasing oxygen requirements and an acute kidney injury. On day 9, continuous haemodiafiltration was commenced; however, hypercalcaemia proved resistant to maximal therapy. His initial parathyroid hormone (PTH) level measured 371 ng/L, and an ultrasound of his neck revealed a 2 × 2.5 cm parathyroid mass in the inferior neck. An acute parathyroidectomy was performed following which his chest infiltrates resolved and serum calcium levels returned to within normal range. Conclusions This case highlights primary hyperparathyroidism and the resulting hypercalcaemia as a sole cause for multi-organ failure in an otherwise well patient.

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“…Ancak, maksimum etkilerinin 48-72 saat sonra başlaması ve birkaç hafta sürmesi nedeniyle idame tedavisi için daha uygun ilaçlardır. Ayrıca böbrek yetmezliği varlığında dikkatli kullanılmalıdırlar (8) . Bu tedavilerle kıyaslandığında, serum kalsiyum düzeyinin acil olarak azaltılması gerektiği şiddetli hiperkalsemide hemodiyalizin daha etkin olduğu gösterilmiştir (8,9) .…”

Section: Discussionunclassified

Continuous veno-venous hemodiafiltration in severe hypercalcemia due to metastatic lung cancer: A case report

Tuncalı¹,

Cabbaroğlu²,

Kirkayak³

et al. 2020

JARSS

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En sık olarak neoplastik hastalıklar ve primer hiperparatiroidi nedeniyle gelişen şiddetli hiperkalsemi, nörolojik, kardiyovasküler ve renal fonksiyonlarda ciddi bozulmalara yol açabilen, nadir ancak yaşamı tehdit edici bir elektrolit bozukluğudur. Bu makalede, metastatik akciğer kanserine bağlı ciddi hiperkalsemi, akut böbrek hasarı ve bozulmuş hemodinami nedeniyle yoğun bakımda sürekli venö-venöz hemodiyafiltrasyon (CVVHDF) ve destek tedavisi ile başarıyla tedavi edilen olguyu sunduk.

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Management of hypercalcaemic crisis in adults: Current role of renal replacement therapy

Cited by 7 publications

References 9 publications

Regional citrate anticoagulation versus low molecular weight heparin anticoagulation for continuous venovenous hemofiltration in patients with severe hypercalcemia: a retrospective cohort study

Regional citrate anticoagulation versus low molecular weight heparin anticoagulation for continuous venovenous hemofiltration in patients with severe hypercalcemia: a retrospective cohort study

A case of multi-organ failure due to hyperparathyroidism-related hypercalcaemia

Continuous veno-venous hemodiafiltration in severe hypercalcemia due to metastatic lung cancer: A case report

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