Hypercalcemia: Is Dialysis Still an Option?

Abstract

Hypercalcemia is a common disorder that can cause acute kidney failure, neurological damage up to coma, arrhythmia and cardiac arrest. The management of hypercalcemia is based on intravenous hydration with normal saline, when insufficient, bisphosphonate treatment is used. More recently, denosumab has shown significant benefit. Hemodialysis is an additional option in the treatment of severe refractory hypercalcemia when medical treatment is deemed ineffective or unavailable. It allows rapid correction of calcium levels, especially in patients with renal failure or cardiac co-morbidities, where hydration cannot be performed safely. The aim of our study was to compare hemodialysis as a therapeutic tool, to more conservative treatments. Our study is retrospective, descriptive, analytical and comparative, sprawling from January 2015 to June 2019 at the university hospital Hassan II in Fez. 78 patients with hypercalcemia were studied. The mean age was 55 ± 15 years and sex ratio M/F of 1.1. The mean corrected serum calcium at admission was 144 mg/l ± 23 mg/l. Malignancies represented 72.7% of all etiologies. Kidney injury was observed in 50 of our patients (64%). Mortality was noted in 16.6% of all cases. When comparing the 2 groups (patient on dialysis versus patient under other treatments), electrocardiogram abnormalities, patient who had high levels of calcium and those who had hyperparathyroidism were more likely to be on dialysis rate. In our study, even though we used relatively high calcium dialysate, we were able to achieve a decrease of 39% in patient’s calcemia in the hemodialysis group versus 27% decrease when using a combination of forced saline dieresis and bisphosphonate without a difference in term of mortality.