Malignant Hypercalcaemia Requiring Acute Haemodialysis: A Case Series of 36 Patients

Introduction: Hypercalcaemia is a common metabolic disorder. Malignant hypercalcaemia is defined as a serum calcium level exceeding 3.5 mmol/L, associated with life-threatening cardiovascular or neurological consequences. Haemodialysis may be indicated when malignant hypercalcaemia fails to respond to first-line treatment. The aim of this study was to characterise the epidemiological, aetiological, therapeutic, and clinical outcomes of patients with malignant hypercalcaemia requiring haemodialysis. Material and methods: This retrospective study was conducted over a 24-month period (January 2021–January 2023) and included patients who underwent emergency haemodialysis in the Nephrology Department of Ibn Rochd University Hospital, Casablanca, with malignant hypercalcaemia as the primary indication. Epidemiological, clinical, biochemical, and follow-up data were collected and analysed using SPSS Statistics version 20. Results: Thirty-six patients were enrolled (mean age 55.08 ± 14.9 years; male-to-female ratio 2:1). Neoplastic disease was present in 80.6% of patients (solid tumours in 50%; haematological malignancies in 30.5%). All patients presented with altered general condition; dyspnoea was reported in 41.6% and neurological disorders in 27.8%. Physical examination revealed extracellular dehydration (91.7%), tachycardia (100%), and oligo-anuria (16.7%). Renal failure was documented in 72.2% and anaemia in 80.6% of patients. Mean corrected serum calcium was 169.16 ± 17.2 mg/L. Electrocardiographic signs of hypercalcaemia were present in all patients. All patients received one or more sessions of intermittent haemodialysis (mean 1.79 sessions per patient). Symptomatic management included intravenous fluid resuscitation, bisphosphonates (90%), loop diuretics after volume restoration (36.1%), and corticosteroids (22.2%). Serum calcium normalised in 26 patients (72.2%). Mortality at the end of the study period was 22.2%. Conclusion: Malignant hypercalcaemia remains a potentially life-threatening condition owing to its cardiovascular, neurological, and renal complications. Malignant disease is the predominant aetiology. Haemodialysis constitutes a rapidly effective and potentially life-saving intervention in cases of hypercalcaemia with cardiac compromise.