Severe Hypocalcemia and Hypomagnesemia with Denosumab in Advanced Chronic Kidney Disease: Case Report and Literature Review.

Background. Denosumabhas become the preferred agent over zolendronic acid to help prevent skeletal-related events in patients with metastatic bone diseaseand multiple myeloma because it is approved for use in those with kidney dysfunction. However, denosumabhas been linked to cases of hypocalcemia, particularly in those with advanced kidney disease. Case Presentation. We present the case of a patient with metastatic prostate cancer and chronic kidney diseasedue to obstructive nephropathy who developed severe hypocalcemia and hypomagnesemiaafter denosumabinjection, which required intensive care unit admission, aggressive calcium supplementation, and hemodialysis assistance. We reviewed the evidence behind the safety profile of denosumabin chronic kidney disease, and we also looked at additional factors that may precipitate severe hypocalcemia with denosumabin advanced kidney disease. Conclusion. We believe that denosumabshould be avoided in advanced chronic kidney diseasedue to the potential life-threatening, severe hypocalcemia that has been observed.