From the Guidelines
Chronic kidney disease is a risk factor for developing hypercalcemia, particularly in the context of therapy with calcium-based phosphate binders and/or active vitamin D sterols, as noted in the K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease 1.
Risk Factors for Hypercalcemia
The following are risk factors for hypercalcemia:
- Chronic kidney disease, as it may lead to difficulties in buffering increased calcium loads, resulting in hypercalcemia and/or soft-tissue calcification 1
- Exogenous vitamin D use, which can contribute to hypercalcemia in CKD patients 1
Conditions Not Typically Associated with Hypercalcemia
The following conditions are not typically associated with hypercalcemia:
- Exogenous vitamin C use, which is not associated with calcium abnormalities
- Hyperphosphatemia, which often accompanies hypocalcemia rather than causing hypercalcemia
- Hypoparathyroidism, which leads to hypocalcemia due to insufficient parathyroid hormone
Clinical Considerations
It is essential to maintain normal serum levels of phosphorus in CKD patients to prevent abnormalities in parathyroid hormone metabolism and reduce morbidity and mortality 1. Additionally, CKD patients may have reduced net calcium absorption due to decreased calcium intake and decreased fraction of calcium absorbed by the intestine, making it crucial to monitor and manage calcium levels carefully 1.
From the Research
Risk Factors for Hypercalcemia
The following are risk factors for developing hypercalcemia:
- Sarcoidosis: Studies have shown that sarcoidosis is a significant risk factor for developing hypercalcemia 2, 3, 4, 5, 6
- Exogenous vitamin D use: Vitamin D supplementation has been linked to an increased risk of hypercalcemia in sarcoidosis patients 3, 5
- Chronic kidney disease: Renal insufficiency has been documented in a significant proportion of sarcoidosis patients with hypercalcemia, suggesting a potential link between chronic kidney disease and hypercalcemia 3, 5
Conditions Not Typically Associated with Hypercalcemia
The following conditions are not typically associated with an increased risk of hypercalcemia:
- Hyperphosphatemia: There is no direct evidence to suggest that hyperphosphatemia is a risk factor for hypercalcemia in the context of sarcoidosis
- Hypoparathyroidism: Hypoparathyroidism is not typically associated with hypercalcemia, as it is characterized by decreased parathyroid hormone levels, which would actually decrease calcium levels in the blood