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Open AccessCase Report

Contrasting PTH Response of Denosumab Use in Dialysis Patients: A Report of 2 Cases

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
Pacific Nephrology, Concord, CA 94520, USA
Department of Internal Medicine Nephrology Division, Loma Linda University School of Medicine, Loma Linda, CA 92350, USA
Author to whom correspondence should be addressed.
Pharmacy 2020, 8(2), 59;
Received: 14 February 2020 / Revised: 29 March 2020 / Accepted: 30 March 2020 / Published: 1 April 2020
(This article belongs to the Special Issue Pharmacokinetics of Drugs and Dosing in Kidney Disease)
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 (>5000 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). View Full-Text
Keywords: denosumab; calcium; parathyroid hormone; end-stage renal disease; hemodialysis denosumab; calcium; parathyroid hormone; end-stage renal disease; hemodialysis
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Jang, S.M.; Anam, S.; Pringle, T.; Lahren, P.; Infante, S. Contrasting PTH Response of Denosumab Use in Dialysis Patients: A Report of 2 Cases. Pharmacy 2020, 8, 59.

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