Richards K1, Spencer L1, O’Lone E1,2

1Royal North Shore Hospital, Sydney, Australia, 2The University of Sydney, Camperdown, Australia

Aim: To evaluate the incidence and duration of serum hypocalcaemia following denosumab administration in haemodialysis patients

Background: Chronic kidney disease-mineral and bone disease (CKD-MBD) is prevalent in haemodialysis patients.  In addition to managing parathyroid hormone (PTH), phosphate and Vitamin D, there is increasing use of anti-resorptive agents such as Denosumab (a human monoclonal antibody targeting RANKL with minimal renal filtration). The main side effect of Denosumab is hypocalaemia and in the general population the nadir is 8-11 days with monitoring recommended for two weeks.  Dialysis patients are known to be at higher risk of hypocalcaemia but there are no guidelines for the duration of monitoring in this population.

Methods: We conducted a single-centre retrospective review of prevalent patients receiving haemodialysis (n=98). Hospital and renal unit database records were reviewed to identify patients that had received denosumab in the past 12 months. We collated baseline demographics, documented calcium supplementation and serum corrected calcium levels pre-denosumab dosing and for 12 weeks following.

Results: Eight patients received denosumab. The median age was 77 (73.21-85.75) and five (62.5%) were female. No patients were hypocalcaemic prior to receiving denosumab. All patients were given additional supplementation post Denosumab.  Despite this, six patients (75%) developed serum hypocalcaemia in the 12 weeks (range 1.7–2.69 mmol/L) with four requiring ongoing supplementation after 12 weeks. Fortunately, no adverse events were recorded. Three patients remained hypocalcaemic at 12 weeks.

Conclusions: Dialysis patients are at high risk of prolonged hypocalcaemia following Denosumab administration. Calcium monitoring should be continued for up to 12 weeks. Further studies are required regarding the medium- and long-term effects of denosumab in this subgroup.


Dr Katherine Richards is a Resident Medical Officer based at Royal North Shore Hospital in Sydney, NSW. She graduated from The University of New South Wales with a Bachelor of Medical Science and Doctor of Medicine. Katherine has a keen interest in nephrology, with a particular interest in preventative renal medicine and renal transplants.

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