Would you consider treating hypercalcemia with CRRT and regional citrate anticoagulation for a dialysis dependent patient who does not respond to bisphosphonate therapy and low calcium dialysate bath?

Although CRRT with citrate anticoagulation may be effective in treating significant hypercalcemia, this is only a temporary solution if the underlying etiology of hypercalcemia persists. The underlying cause of hypercalcemia should be addressed, if possible. If the underlying etiology cannot be easily treated, then denosumab may be a good option. Since denosumab may significantly lower serum calcium level in dialysis patients, denosumab may be a good therapeutic option in this patient with refra...

In a dialysis dependent patient, I would not use the RRT to control calcium as its effect is transient. Patients should still be treated according to the pathophysiology of hypercalcemia. If bisphosphonate or denosumab therapy is ineffective at controlling calcium, then I would consider if there is another mechanism to hypercalcemia (i.e. 1,25 OH vitamin d mediated hypercalcemia) which may benefit to steroids. Another consideration is the shifts of calcium with hemodialysis may also be a problem...