Denosumab for treatment of immobilization-related hypercalcemia in a patient with end-stage renal disease

Abstract

The efficacy and safety of denosumab for the treatment of immobilization-related hypercalcemia in end-stage renal disease remain uncertain. We describe the case of a hemodialysis patient with immobilization-related hypercalcemia who was successfully treated with denosumab. A 79-year-old man admitted for hemodialysis after sustaining an acute kidney injury developed immobilization-related hypercalcemia due to the impairment resulting from an acute myocardial infarction, acute heart failure, and catheter-related bloodstream infection. After admission, the patient's corrected serum calcium rose to 12.9 from 8.8 mg/dL. A bisphosphonate (alendronate) was administered, but it was ineffective. Subsequently, treatment with denosumab proved to be effective and his corrected serum calcium level declined to 9.3 mg/dL within 1 week. Hypocalcemia, which is an adverse effect of denosumab, was prevented using active vitamin D and calcium supplementation, and his calcium level stabilized. Thus, our case demonstrates that denosumab is a viable therapeutic option for dialysis patients experiencing immobilization-related hypercalcemia.

Keywords: Denosumab; End-stage renal disease; Hypercalcemia; Immobilization.

Fig. 1

Corrected serum calcium and inorganic phosphorus levels over the course of hospitalization. The period of immobilization and various treatments for hypercalcemia are shown. Serum osteocalcin (a bone resorption marker) and serum type 1 collagen cross-linked N-telopeptide and tartrate-resistant acid phosphatase-5b, (bone formation markers) before (left) and after (right) denosumab treatment are shown below the graph. PO per os, SQ subcutaneously, Ca calcium, OC osteocalcin, NTX type 1 collagen cross-linked N-telopeptide, TRACP5b tartrate-resistant acid phosphatase-5b