Abstract
Hypercalcemia is one of the life-threatening complications of malignant neoplasms. We, therefore, investigated the effects of Ca-free HD on hypercalcemia associated with malignant neoplasms. Seven patients with hypercalcemia associated with malignant neoplasms (4 adult T-cell leukemia, 1 parathyroid tumor, 1 uterus cancer, 1 multiple myeloma) were treated with Ca-free HD in order to improve their critical hypercalcemia. The levels of serum creatinine and blood urea nitrogen before HD were 2.6±1.4mg/dl and 63±27mg/dl respectively. The contents of the Ca-free dialysate which was used in this study were 135mEq/l of Na+, 2.5mEq/l of K+, 103mEq/l of CI-, 8mEq/l of CH3 COO-, and 30mEq/l of HCO3-. Ca-free HD significantly reduced the serum Ca (Ca2+) concentrations of the patients from 15.1±2.5mg/dl (4.61±1.09mEq/l) to 11.4±1.4mg/dl (3.01±0.24mEq/l). Clinical symptoms such as unconsciousness were markedly improved. The serum Ca concentration at one hour after the start of Ca-free HD had decreased to 82.3% of the pre-HD value. The reduction rate of serum Ca (Ca2+) concentration was highest during the first hour of Ca-free HD. There was a significant correlation between initial serum Ca concentrations and the amounts of reduction of serum Ca concentration caused by Ca-free HD. Twenty-four hours after Ca-free HD, serum Ca concentrations again increased to almost the same values as before the treatment. These results indicate that Ca-free HD could markedly and rapidly improve critical hypercalcemia despite its effect being transient. As it takes at least half a day to improve critical hypercalcemia with drugs such as mithramycine, Ca-free HD should be utilized as an emergent treatment for patients with life-threatened hypercalcemia.
