Jang Soo Min, Anam Smitha, Pringle Tara, Lahren Paul, Infante Sergio
Department of Pharmacy Practice, Loma Linda University School of Pharmacy, Loma Linda, CA 92350, USA.
Loma Linda University Kidney Center, Loma Linda, CA 92354, USA.
Pharmacy (Basel). 2020 Apr 1;8(2):59. doi: 10.3390/pharmacy8020059.
A common complication of end-stage renal disease (ESRD) is mineral and bone disorder. Yet, many anti-osteoporotic drugs are contraindicated in ESRD patients. Denosumab, a monoclonal antibody, does not require renal dose adjustment. However, its use is uncertain due to a lack of safety and efficacy of data in this population. Two hemodialysis patient cases of contrasting responses in parathyroid hormone (PTH) after denosumab administration were observed. Patient 1, a 62-years-old male received denosumab 60 mg at Day 0. His calcium decreased from 8.8 mg/dL to 6.8 mg/dL on Day 30. The PTH level increased from 265 pg/mL to 372 pg/mL after 30 days. Calcium and PTH levels approached normal range after increasing doses of vitamin D/calcium supplements, and calcitriol. Patient 2, a 72-years-old male on hemodialysis also received denosumab 60 mg on Day 0. His baseline calcium and PTH were 9.2 mg/dL and 420 pg/mL, respectively. On Day 30, his calcium level decreased (6.8 mg/dL) but, PTH level drastically increased (>5,000 pg/mL). Denosumab commonly causes hypocalcemia and hyperparathyroidism since it inhibits osteoclast activation, reduces calcium release from bone and increases PTH levels as a compensatory mechanism. With a wait-and-watch approach, Patient 2's levels approached the normal range (calcium 9.6 mg/dL and PTH 274 pg/mL at Day 90).
终末期肾病（ESRD）的一种常见并发症是矿物质和骨代谢紊乱。然而，许多抗骨质疏松药物在ESRD患者中是禁忌的。地诺单抗，一种单克隆抗体，不需要进行肾脏剂量调整。然而，由于该人群缺乏安全性和有效性数据，其使用存在不确定性。观察到两例血液透析患者在使用地诺单抗后甲状旁腺激素（PTH）反应截然不同的病例。患者1，一名62岁男性，在第0天接受了60mg地诺单抗。他的血钙在第30天从8.8mg/dL降至6.8mg/dL。30天后PTH水平从265pg/mL升至372pg/mL。在增加维生素D/钙补充剂和骨化三醇的剂量后，血钙和PTH水平接近正常范围。患者2，一名72岁接受血液透析的男性，同样在第0天接受了60mg地诺单抗。他的基线血钙和PTH分别为9.2mg/dL和420pg/mL。在第30天，他的血钙水平下降（至6.8mg/dL），但PTH水平急剧上升（>5000pg/mL）。地诺单抗通常会导致低钙血症和甲状旁腺功能亢进，因为它抑制破骨细胞活化，减少骨钙释放，并增加PTH水平作为一种代偿机制。采取观察等待的方法后，患者2的各项指标在第90天接近正常范围（血钙9.6mg/dL，PTH274pg/mL）。
