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Persistent severe hypercalcemia during maintenance hemodialysis

W J Johnson

    Annals of Internal Medicine
    |August 1, 1980
    PubMed
    Summary
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    Persistent hypercalcemia can occur after hemodialysis, even without high parathyroid hormone levels or bone disease. Renal transplantation may temporarily resolve hypercalcemia, but it can return with resumed dialysis.

    Area of Science:

    • Nephrology
    • Endocrinology
    • Biochemistry

    Background:

    • Hypercalcemia is a common complication in patients with chronic kidney disease.
    • The role of parathyroid hormone (PTH) in dialysis-induced hypercalcemia is not fully understood.

    Observation:

    • Three patients developed hypercalcemia shortly after initiating hemodialysis.
    • These patients had normal serum alkaline phosphatase and no evidence of hyperparathyroid bone disease or metastatic calcification.
    • Serum PTH concentrations were not markedly elevated in these patients.

    Findings:

    • Parathyroidectomy in two patients normalized PTH but did not resolve hypercalcemia.
    • Renal transplantation temporarily corrected hypercalcemia in a third patient, but it recurred upon resumption of hemodialysis after allograft nephrectomy.

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    Implications:

    • This suggests that factors beyond PTH and bone disease contribute to hypercalcemia during hemodialysis.
    • Further research is needed to identify the mechanisms and potential treatments for dialysis-induced hypercalcemia.
    • Understanding these mechanisms is crucial for managing mineral and bone disorders in chronic kidney disease patients.