Persistent severe hypercalcemia during maintenance hemodialysis

Hypercalcemia appeared shortly after induction of hemodialysis in three patients in whom serum parathyroid hormone concentrations were not markedly elevated, whose serum alkaline phosphatase values were normal, and in whom skeletal surveys did not show hyperparathyroid bone disease or metastatic calcification. Parathyroidectomy in two patients resulted in a decrease in parathyroid hormone concentration to normal, but hypercalcemia persisted. In a third patient, who was not subjected to parathyroidectomy, serum calcium values returned to normal after each of two renal transplantations but remained moderately elevated each time hemodialysis was resumed after allograft nephrectomy.