WORSENING OF NON-DIABETIC HYPOGLYCEMIA IN HEMODIALYSIS-DEPENDENT PATIENT: A CASE REPORT

Background: Hypoglycemia in non-diabetic hemodialysis patients is a rare but clinically significant phenomenon. Patients with end-stage renal disease (ESRD) are particularly susceptible to glucose dysregulation due to factors such as altered insulin metabolism, impaired renal clearance, and medication effects. Calcimimetic agents, including cinacalcet and etelcalcetide, are widely used to manage secondary hyperparathyroidism in ESRD patients. However, their potential impact on glucose metabolism remains poorly understood. This case report describes a 64-year-old male with ESRD who experienced frequent and severe hypoglycemic episodes following the transition from oral cinacalcet to intravenous etelcalcetide.

Case Presentation: A 64-year-old male with ESRD on hemodialysis three times per week developed recurrent and severe hypoglycemia after switching from oral cinacalcet to intravenous etelcalcetide. Prior to the switch, the patient had a history of infrequent, mild hypoglycemia. However, after initiating etelcalcetide, his blood glucose levels dropped as low as 49 mg/dL, and he experienced a hypoglycemic seizure with a blood glucose level of 53 mg/dL. Following a switch back to oral cinacalcet, the frequency and severity of hypoglycemic episodes returned to baseline.

Conclusion: While a direct causal relationship between intravenous etelcalcetide and hypoglycemia cannot be definitively established, the temporal association and clinical course suggest a potential link. This case highlights the need for vigilant monitoring of glucose levels in hemodialysis patients on calcimimetic therapy, particularly during transitions between formulations. Further research is warranted to explore the mechanisms underlying this association.