Next Article in Journal / Special Issue
Relationship between 2-Hour Tacrolimus Concentrations and Clinical Outcomes in Long Term Kidney Transplantation
Previous Article in Journal
Enhancing Pharmaceutical Packaging through a Technology Ecosystem to Facilitate the Reuse of Medicines and Reduce Medicinal Waste
Previous Article in Special Issue
Prescribing and Safety of Direct-Acting Oral Anticoagulants Compared to Warfarin in Patients with Atrial Fibrillation on Chronic Hemodialysis
Open AccessCase Report

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

1
Department of Pharmacy Practice, Loma Linda University School of Pharmacy, Loma Linda, CA 92350, USA
2
Loma Linda University Kidney Center, Loma Linda, CA 92354, USA
3
Pacific Nephrology, Concord, CA 94520, USA
4
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; https://doi.org/10.3390/pharmacy8020059
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
Show Figures

Figure 1

MDPI and ACS Style

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.

Show more citation formats Show less citations formats
Note that from the first issue of 2016, MDPI journals use article numbers instead of page numbers. See further details here.

Article Access Map by Country/Region

1
Search more from Scilit
 
Search
Back to TopTop