The Use of Low-Calcium Hemodialysis in the Treatment of Hypercalcemic Crisis

Abstract

Background: We reviewed the results of low-calcium hemodialysis (LCHD; 1.25 mmol/L) in the treatment of 42 cases admitting with hypercalcemic crisis. Methods: All patients (≥18 years) who started LCHD due to hypercalcemia between 2002 and 2017 were retrospectively analyzed. Biochemical data were obtained at the beginning of the first hemodialysis and at the end of the last hemodialysis. ­“Refractory” cases were defined as patients having albumin corrected serum total calcium (SCa_total) levels above 10.2 mg/dL despite of all medical, surgical, and hemodialysis treatments. Results: By acceptance of 3 cases admitted again over 6 months as new cases, a total of 42 cases (male, 57.1%) with a mean age of 55.9 ± 14.8 years underwent urgent hemodialysis. Most of the patients (82.1%) had malignancies. The mean SCa_total level at the beginning of hemodialysis sessions was 15.89 ± 2.53 mg/dL. The mean decline of SCa_total level was 4.63 ± 2.72 mg/dL. Refractory cases received hemodialysis after admission significantly later than improved cases (48 [interquartile ranges (IQR) 24–168] vs. 24 [IQR 12–48] h, p = 0.010). Serum creatinine and SCa_total levels at the last visit were significantly more in refractory cases than improved cases (1.92 [IQR 0.81–3.41] vs. 1.30 [IQR 0.8–1.7] mg/dL, p = 0.031 and 12.43 ± 2.53 vs. 8.86 ± 0.67 mg/dL, p = 0.000 respectively). Mortality was significantly higher in refractory cases than improved cases (58.8 vs. 10.5%, p = 0.002). Overall mortality rate was 33.3%. Conclusion: Hypercalcemic crisis is a life-threatening condition and should be managed immediately.

Primary Hyperparathyroidism Masquerading as Acute Pancreatitis

“…Out of these 3 patients, calcium level normalized in 2 patients after single session of hemodialysis and the remaining 1 patient was successfully treated with denosumab. Hemodialysis is typically not the first line treatment of hypercalcemia in patients with PHPT; however, it could be used in patients with refractory hypercalcemia, associated renal failure and conditions requiring immediate lowering of calcium levels such as cardiac and neurological involvement [25]. There is dearth of literature on the use of denosumab in patients with PHPT with renal failure.…”

Hypotension associated with high cardiac output and low systemic vascular resistance in a patient with hyperparathyroidism and hypercalcemia

“…The use of ‘low calcium hemodialysis’ for hypercalcemic crisis or refractory hypercalcemia is well known. [ 3 ] But the effect of dialysis on the cardiovascular system in primary hyperparathyroidism using advanced cardiac output monitoring has not been documented in the literature. Parathormone is a direct vasodilator and can decrease SVR by the endothelial release of nitric oxide (eNO).…”