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Abstract: SA-PO194

Risk of Hypocalcemia With Denosumab Use in CKD Patients

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical

Authors

  • Kalipatnapu, Sri Mahathi Priyanka, University of Chicago Pritzker School of Medicine, Chicago, Illinois, United States
  • Bhargava, Juhi, University of Chicago Pritzker School of Medicine, Chicago, Illinois, United States
  • Hasan, Shirin, NorthShore University HealthSystem, Evanston, Illinois, United States
  • Sprague, Stuart M., NorthShore University HealthSystem, Evanston, Illinois, United States
Background

Several case reports and retrospective studies have demonstrated that denosumab (DNB) can cause hypocalcemia in advanced CKD (4-5) and ESRD patients. However, these are predominantly anecdotal reports and the prevalence of hypocalcemia in patients with CKD 3-4 is unclear. We evaluated the change in serum calcium (Ca) in patients treated with DNB with CKD stage 3B and 4.

Methods

A retrospective study on 52 patients with CKD 3B-4 who were treated with DNB between 2017-2021 was performed. Mean (+ SE) number of doses of DNB received was 2.4 + 0.14 with minimum of 1 and maximum of 4 doses. Mean pre and post Ca, PTH, vitamin D and phosphorus (Phos) were evaluated. The patients were stratified based on their eGFR into CKD 3B and CKD 4. The subgroup of patients with hypocalcemia (defined < 8.0 mg/dL) and decrease in calcium greater than 1mg/dl from baseline were also identified.

Results

The 52 patients received 122 (2.4 + 0.14) doses of DNB and had a mean eGFR of 37 + 0.7. Mean serum Ca (mg/dL) was 9.6 + 0.05 and 9.3 + 0.05 before and after DNB, respectively. Mean change in serum Ca was 0.29 + 0.06. There were 21 patients with CKD stage 4, mean eGFR 24.2 + 7.7. Mean serum Ca with was 9.5 + 0.16 before DNB and 9.2 + 0.13 after DNB. Mean change in Ca was 0.4 + 0.14. In the 99 patient events with eGFR between 30-45 (39.7 + 0.58), the mean Ca was 9.7 + 0.05 before DNB 9.4 +0.06 after DNB. Mean change in Ca was 0.3 + 0.07. In 15 patients (18 patient events) there was a decrease in serum Ca > 1 mg/dl. The mean eGFR was 32.1 + 1.9 with mean Ca of 10.0 + 0.14 and 8.6 + 0.18 pre and post DNB, respectively, and a mean change in Ca of 1.36 + 0.09. Only one patient had overt hypocalcemia, with a post DNB Ca of 7.7 and an eGFR of 27. Vitamin D was available in 6 patients with mean vitamin D (ng/mL) of 50.7 + 2.3 and 51.2 + 3.8 before and after DNB, respectively. PTH was available in 5 patients with mean PTH (pg/mL) 90.6 + 29.0 and 93.8 34.3 before and after DNB, respectively. Phos was available in 11 patients and mean phos (mg/dL) was 3.4 + 0.10 and 3.3 + 0.39 before and after DNB, respectively.

Conclusion

DNB did not cause a significant drop in Ca in this random sample of CKD 3B-4 patients. Patients with CKD 4 should be monitored for hypocalcemia, further larger and prospective studies should be performed.

Funding

  • Clinical Revenue Support