Severe Symptomatic Hypocalcemia after Denosumab Administration in an End-Stage Renal Disease Patient on Peritoneal Dialysis with Controlled Secondary Hyperparathyroidism
Mohit Agarwal, Éva Csongrádi, Christian A. Koch, Luis A. Juncos, Vonda Echols, Mihály Tapolyai, Tibor Fülöp
Journal of Advances in Medicine and Medical Research · pp. 1398–1406 · Published 23 Apr 2013
10.9734/BJMMR/2013/2989Abstract
We report the 1st case of severe, symptomatic hypocalcemia after denosumab (RANKL inhibitor) treatment in a peritoneal dialysis patient with secondary hyperparathyroidism and osteoporosis. A 58-year-old Caucasian female has been receiving chronic ambulatory peritoneal dialysis for four years secondary to polycystic kidney disease. Laboratory studies revealed: albumin-corrected calcium 9.0 mg/dL, phosphorus 5 mg/dL, alkaline phosphatase (ALP) 58 U/L [normal, 40-105], albumin 3.4 gm/dL [normal, 3.6-5.4] and intact parathyroid hormone (PTH) 315 pg/mL [normal, 40-72]. Marked osteoporosis was noted on the DXA scan, preventing her from renal transplantation considerations. She had failed conventional medical treatment, including per os calcium, monthly ergocalciferol (50,000 units/month), activated vitamin-D analog (doxercalciferol) and renal-failure adjusted alendronate (70 mg twice a month). She was started on subcutaneous denosumab 60 mg every 6 months. After her first dose, she developed a progressive drop of calcium, phosphorus, bicarbonate and magnesium, in spite of massive escalation of doxercalciferol and calcium supplementation. Hypocalcemia nadired at 6.3 mg/dL with symptomatic tetany, requiring a brief hospitalization approximately 7 weeks after denosumab treatment. Her elevated PTH rose further transiently (647 pg/mL), along with ALP (123 U/L). Bone-mineral parameters normalized approximately 3 months after denosumab administration. The observed phenomenon resembled the phenotype of “hungry bone syndrome” observed after surgical parathyroidectomy. Conclusion: Treatment decisions based on bone densitometry results alone are not transposable between patients with or without end-stage renal disease. Denosumab may lead to critical hypocalcemia in dialysis patients and further aggravate existing secondary hyperparathyroidism.
Cited by 12
L V Egshatyan, L Ya Rozhinskaya · Osteoporosis and Bone Diseases · 2014
Amit Nachankar, Amit Katyal, Naresh Bansal · BMJ Case Reports · 2022
Tibor Fülöp, Lajos Zsom, Mihály B. Tapolyai · Medical Hypotheses · 2017
Andrea Cowan, Nivethika Jeyakumar, Eric McArthur · Journal of Bone and Mineral Research · 2020
Hiroya Takami, Kazunori Washio, Hiromichi Gotoh · International Journal of Nephrology · 2017
· Arzneimitteltherapie in der Palliativmedizin · 2022
Sylvie Dusilová Sulková, Jiří Horáček, Roman Šafránek · Acta Medica (Hradec Kralove, Czech Republic) · 2014
Sohail Abdul Salim, Lakshmi Ramachandran Nair, Litty Thomas · The American Journal of the Medical Sciences · 2018
Sabahat Afshan, Abdeen R. Farah Musa, Vonda Echols · The American Journal of the Medical Sciences · 2017
Yukihiro Wada, Masayuki Iyoda, Ken Iseri · The Tohoku Journal of Experimental Medicine · 2016
Related research
- Impediments that Challenged Therapeutic Plasma Exchange: Experience at a Tertiary Care Hospital in Bangladesh — shares topic coverage
- Familial Hypomagnesemia with Secondary Hypocalcemia: A Challenging Medical Affair — shares topic coverage
- Ultrastructure of Thyroid and Parathyroid Bodies in Case of Hypocalcemia and Hypercalcemia — shares topic coverage
- Acute Phosphate Nephropathy Successfully Treated with Hemodialysis: A Case Report and Literature Review — shares topic coverage
- Prevalence of Biochemical Abnormalities in Neonatal Seizures in Term and Preterm Neonates — shares topic coverage
Article metrics
Real usage data collected on this platform.
1
Page views
0
PDF downloads
0
Outbound clicks
12
Citations
Views over time
Views by country
Approximate, from request IP at view time — not citizenship or institution. Countries with fewer than 5 views are grouped as "Other".
Traffic sources
Referring site, by host.
Views and downloads exclude known bots/crawlers. Citations combines this platform's own DOI-resolved index with each external source's own reported total — see Cited by above for individually listed citing works. Last refreshed 0 seconds ago.