Are there instances when you recommend initiation of hemodialysis for patients with severe symptomatic hypercalcemia?

In reality, there are so many treatments for hypercalcemia nowadays that the answer to the question is no. However, I can imagine if a patient is already on the cusp of needing dialysis and is hypercalcemic then I may initiate dialysis a little earlier to fix the hypercalcemia sooner.

Frankly, I never thought about HD for hyperCa until Endocrine brought it up, which they seem to do a lot lately. Having said that, it has rarely been necessary, but I have NO problem doing it for a severe increase in ionized Ca that is refractory to medical management. Remember, even a 2.5 meq/l dialysate is 1.25 ionized and will reduce the patient's Ca (assuming iCa higher than that, if not higher than that, I wouldn't do it...).