Calcium free hemodialysis: experience in the treatment of 33 patients with severe hypercalcemia

Abstract

Objective: To assess the efficacy, adverse effects and relevance of calcium-free hemodialysis (CFHD) in the treatment of major hypercalcemia.

Design: Retrospective chart review.

Setting: Medical ICU.

Patients: All patients admitted over a 9-year period for hypercalcemia requiring urgent treatment and who underwent hemodialysis.

Interventions: CFHD with an acetate dialysate.

Main results: Thirty-three patients with severe hypercalcemia from various etiologies received CFHD. Marked and rapid decrease of serum total calcium was obtained during all sessions (mean decrease: 1.71 +/- 0.54 mmol/l). Calcium rebound within 24 h after CFHD was observed in all evaluable cases (1 +/- 0.45 mmol/l; mean delay 13.7 +/- 5.8 h). Adverse cardiovascular effects occurred in 17 of 48 sessions (35%) and in 13 of 30 evaluable patients (43%).

Conclusions: Adverse effects are frequent during CFHD. After correction of hypovolemia, its use should be restricted to patients with severe clinical symptoms or advanced renal impairment.