Division of Nephrology, Department of Medicine, Dalhousie University, Nova Scotia, Canada.
Queen Elizabeth II Health Sciences Center, Nova Scotia, Canada.
Perit Dial Int. 2020 Jan;40(1):103-106. doi: 10.1177/0896860819880095.
Hypercalcemia due to excess parathyroid hormone (PTH) production is a common condition among patients with end-stage renal disease (ESRD), often referred to as tertiary hyperparathyroidism. There are limited effective medical treatment options currently available for such patients. Denosumab is a monoclonal antibody that inhibits osteoclast activation, thereby reducing calcium release from bones. Denosumab has been used to treat medically-refractory hypercalcemia in non-ESRD patients with hyperparathyroidism. Denosumab has also been used to treat non-PTH-mediated hypercalcemia in patients with advanced chronic kidney disease and ESRD. In this case report, we describe the use of denosumab to successfully treat a case of medically refractory hypercalcemia due to immobilization in a patient on peritoneal dialysis with severe underlying tertiary hyperparathyroidism. In spite of persistently elevated PTH, hypercalcemia quickly resolved after a single dose of denosumab. The patient subsequently developed temporary hypocalcemia requiring medical intervention. Our case report, which is the first described use of denosumab for treatment of hypercalcemia in the setting of tertiary hyperparathyroidism in a peritoneal dialysis patient, adds to the body of literature suggesting denosumab is a useful therapeutic agent in patients with ESRD. Issues with post-treatment electrolyte management and other therapeutic considerations are also discussed.
甲状旁腺激素（PTH）过度产生导致的高钙血症是终末期肾病（ESRD）患者的常见病症，通常被称为三发性甲状旁腺功能亢进症。目前，此类患者的有效治疗选择有限。地舒单抗是一种单克隆抗体，可抑制破骨细胞的激活，从而减少骨钙的释放。地舒单抗已被用于治疗非 ESRD 甲状旁腺功能亢进患者的药物难治性高钙血症。地舒单抗也被用于治疗晚期慢性肾脏病和 ESRD 患者的非 PTH 介导的高钙血症。在本病例报告中，我们描述了用地舒单抗成功治疗了一名腹膜透析伴严重三发性甲状旁腺功能亢进症的患者因固定而导致的药物难治性高钙血症的病例。尽管 PTH 持续升高，但单次使用地舒单抗后高钙血症迅速得到缓解。此后，患者出现短暂性低钙血症，需要进行医疗干预。本病例报告是首例在腹膜透析患者的三发性甲状旁腺功能亢进症中使用地舒单抗治疗高钙血症的病例，为地舒单抗作为 ESRD 患者的一种有用治疗药物提供了更多的文献依据。还讨论了治疗后电解质管理和其他治疗注意事项等问题。
