Denosumab-Induced Severe Hypocalcaemia in Chronic Kidney Disease

Table 1

Baseline clinical data for 8 patients with CKD stages 4 to 5 who were on denosumab treatment.

Case	Sex	CKD stage	Serum Creatinine; (mol/L)	eGFR; (ml/min/1.73m^2)	Ca2+ prior to denosumab	Corr Ca^2+; (Ref: 2.10 – 2.55 mmol/L) at presentation	(Ref: 0.65 – 1.45 mmol/L)	PTH; (Ref: 0.8 – 5.5 pmol/L)	ALP; (Ref: 30 – 110 units/L)	Vitamin D; (Ref: 60 – 160 nmol/L)	T-score
1	F	5	394	11	2.21	1.42	1.85	55.4	61	75	-3.0
2	F	4	207	20	2.28	1.24	1.02	83.9	77	27	-
3	M	4	289	18	2.11	1.30	2.63	58.2	399	45	-2.5
4	F	5	645	5	2.20	1.20	2.71	80.1	54	54	-2.5
5	F	5D	601	5	2.44	1.80	1.68	59.6	74	90	-3.0
6	F	4T	221	20	2.18	1.70	1.65	15.5	93	62	-1.3†
7	F	4T	234	18	2.38	1.50	0.69	-	101	88	-4.4
8	M	5	410	11	2.14	1.40	1.40	33.3	76	32	-2.7

5D = stage 5 CKD on dialysis and 4T = stage 4 CKD with a renal transplant. All results (including serum phosphate, PTH, ALP, and vitamin D) were obtained closest to the time of presentation with hypocalcaemia in patients who were symptomatic or nadir of hypocalcaemia in patients who were asymptomatic and being actively monitored. All T-scores were obtained based on bone densitometry of the femur except for case 6† who had forearm bone densitometry due to bilateral hip joint replacements. eGFR was calculated using the CKD-EPI formula [8]; Ref = reference range.