Yusuke Sakaguchi, Naohiko Fujii, Tatsuya Shoji, Terumasa Hayashi, Hiromi Rakugi, Yoshitaka Isaka
Hypomagnesemia is a significant predictor of cardiovascular and non-cardiovascular mortality in patients undergoing hemodialysis.
Kidney Int. 2014 Jan;85(1):174-81. doi: 10.1038/ki.2013.327. Epub 2013 Aug 28.
Abstract/Text
Although previous studies in the general population showed that hypomagnesemia is a risk for cardiovascular diseases (CVD), the impact of magnesium on the prognosis of patients on hemodialysis has been poorly investigated. To gain information on this we conducted a nationwide registry-based cohort study of 142,555 hemodialysis patients to determine whether hypomagnesemia is an independent risk for increased mortality in this population. Study outcomes were 1-year all-cause and cause-specific mortality with baseline serum magnesium levels categorized into sextiles. During follow-up, a total of 11,454 deaths occurred, of which 4774 had a CVD cause. In a fully adjusted model, there was a J-shaped association between serum magnesium and the odds ratio of all-cause mortality from the lowest to highest sextile, with significantly higher mortality in sextiles 1-3 and 6. Similar associations were found between magnesium and both CVD and non-CVD mortality. The proportion of patients with a baseline intact parathyroid hormone level under 50 pg/ml was significantly higher in the highest sextile; however, after excluding these patients, the CVD mortality risk in the highest sextile was attenuated. Thus, hypomagnesemia was significantly associated with an increased risk of mortality in hemodialysis patients. Interventional studies are needed to clarify whether magnesium supplementation is beneficial for improving patient prognosis.
Tatsufumi Oka, Takayuki Hamano, Yusuke Sakaguchi, Satoshi Yamaguchi, Keiichi Kubota, Masamitsu Senda, Sayoko Yonemoto, Karin Shimada, Ayumi Matsumoto, Nobuhiro Hashimoto, Daisuke Mori, Chikako Monden, Atsushi Takahashi, Yoshitsugu Obi, Ryohei Yamamoto, Yoshitsugu Takabatake, Jun-Ya Kaimori, Toshiki Moriyama, Masaru Horio, Isao Matsui, Yoshitaka Isaka
Proteinuria-associated renal magnesium wasting leads to hypomagnesemia: a common electrolyte abnormality in chronic kidney disease.
Nephrol Dial Transplant. 2019 Jul 1;34(7):1154-1162. doi: 10.1093/ndt/gfy119.
Abstract/Text
BACKGROUND: Hypomagnesemia (Hypo-Mg) predicts mortality and chronic kidney disease (CKD) progression. However, in CKD, its prevalence, kidney-intrinsic risk factors, and the effectiveness of oral magnesium (Mg) therapy on serum Mg levels is uncertain.
METHODS: In a cross-sectional study enrolling pre-dialysis outpatients with CKD, the prevalence of electrolyte abnormalities (Mg, sodium, potassium, calcium and phosphorus) was compared. In an open-label randomized controlled trial (RCT), we randomly assigned CKD patients to either the magnesium oxide (MgO) or control arm. The outcome was serum Mg levels at 1 year.
RESULTS: In 5126 patients, Hypo-Mg was the most common electrolyte abnormality (14.7%) with similar prevalence across stages of CKD. Positive proteinuria was a risk factor of Hypo-Mg (odds ratio 2.2; 95% confidence interval 1.2-4.0). However, stratifying the analyses by diabetes mellitus (DM), it was not significant in DM (Pinteraction = 0.04). We enrolled 114 patients in the RCT. Baseline analyses showed that higher proteinuria was associated with higher fractional excretion of Mg. This relationship between proteinuria and renal Mg wasting was mediated by urinary tubular markers in mediation analyses. In the MgO arm, higher proteinuria or tubular markers predicted a significantly lower 1-year increase in serum Mg. In patients with a urinary protein-to-creatinine ratio (uPCR) <0.3 g/gCre, serum Mg at 1 year was 2.4 and 2.0 mg/dL in the MgO and control arms, respectively (P < 0.001), with no significant between-group difference in patients whose uPCR was ≥0.3 g/gCre (Pinteraction=0.001).
CONCLUSIONS: Proteinuria leads to renal Mg wasting through tubular injuries, which explains the high prevalence of Hypo-Mg in CKD.
© The Author(s) 2018. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.
E T Wong, R K Rude, F R Singer, S T Shaw
A high prevalence of hypomagnesemia and hypermagnesemia in hospitalized patients.
Am J Clin Pathol. 1983 Mar;79(3):348-52.
Abstract/Text
The prevalence of hypomagnesemia and hypermagnesemia among hospitalized patients was studied by determining magnesium levels in 621 serum samples randomly selected from those submitted to the clinical chemistry laboratory for a biochemical test panel. The reference range for serum magnesium was established in this study as 1.2 to 1.9 mEq/L from measurements of serum magnesium on 341 healthy volunteers. Hypomagnesemia (less than 1.2 mEq/L) was present in 68 patients or 11.0%, and hypermagnesemia (greater than 1.9 mEq/L) occurred in 58 patients or 9.3%. The degree of association between hypomagnesemia and hypocalcemia was assessed by measuring serum magnesium on a separate group of 61 patients with hypocalcemia (corrected calcium less than 8.6 mg/dL). Hypomagnesemia was present in 23.3% of patients hypocalcemic in the absence of renal failure; this proportion was higher significantly than the 11.0% who were hypomagnesemic in the hospitalized patient group (P less than 0.025).
Garrison M Tong, Robert K Rude
Magnesium deficiency in critical illness.
J Intensive Care Med. 2005 Jan-Feb;20(1):3-17. doi: 10.1177/0885066604271539.
Abstract/Text
Magnesium (Mg) deficiency commonly occurs in critical illness and correlates with a higher mortality and worse clinical outcome in the intensive care unit (ICU). Magnesium has been directly implicated in hypokalemia, hypocalcemia, tetany, and dysrhythmia. Moreover, Mg may play a role in acute coronary syndromes, acute cerebral ischemia, and asthma. Magnesium regulates hundreds of enzyme systems. By regulating enzymes controlling intracellular calcium, Mg affects smooth muscle vasoconstriction, important to the underlying pathophysiology of several critical illnesses. The principle causes of Mg deficiency are gastrointestinal and renal losses; however, the diagnosis is difficult to make because of the limitations of serum Mg levels, the most common assessment of Mg status. Magnesium tolerance testing and ionized Mg2+ are alternative laboratory assessments; however, each has its own difficulties in the ICU setting. The use of Mg therapy is supported by clinical trials in the treatment of symptomatic hypomagnesemia and preeclampsia and is recommended for torsade de pointes. Magnesium therapy is not supported in the treatment of acute myocardial infarction and is presently undergoing evaluation for the treatment of severe asthma exacerbation, for the prevention of post-coronary bypass grafting dysrhythmias, and as a neuroprotective agent in acute cerebral ischemia.
Yusuke Sakaguchi, Tatsuya Shoji, Terumasa Hayashi, Akira Suzuki, Morihiro Shimizu, Kensuke Mitsumoto, Hiroaki Kawabata, Kakuya Niihata, Noriyuki Okada, Yoshitaka Isaka, Hiromi Rakugi, Yoshiharu Tsubakihara
Hypomagnesemia in type 2 diabetic nephropathy: a novel predictor of end-stage renal disease.
Diabetes Care. 2012 Jul;35(7):1591-7. doi: 10.2337/dc12-0226. Epub 2012 Apr 12.
Abstract/Text
OBJECTIVE: There is now growing evidence that magnesium (Mg) deficiency is implicated in type 2 diabetes and its complications. However, it has not been fully elucidated whether hypomagnesemia is a predictor of end-stage renal disease (ESRD) in type 2 diabetic nephropathy.
RESEARCH DESIGN AND METHODS: This retrospective cohort study included 455 chronic kidney disease (CKD) patients (144 with type 2 diabetic nephropathy and 311 with nondiabetic CKD) who were hospitalized at Osaka General Medical Center for a CKD educational program between April 2001 and December 2007. The primary outcome was progression to renal replacement therapy. Participants were categorized based on serum Mg level into Low-Mg (serum Mg level ≤1.8 mg/dL) and High-Mg (serum Mg level >1.8 mg/dL) groups with the previously published normal lower limit chosen as the cutoff point.
RESULTS: Of the subjects with type 2 diabetic nephropathy, 102 progressed to ESRD during follow-up (median, 23 months). A multivariate Cox proportional hazards model showed that after adjustment for various demographic factors and laboratory data, the Low-Mg group had a 2.12-fold higher risk of ESRD than the High-Mg group (95% CI 1.28-3.51; P = 0.004). In contrast, 135 of the nondiabetic CKD subjects progressed to ESRD during follow-up (median, 44 months). No significant difference in outcome was found between the Low- and High-Mg groups of this population (adjusted hazard ratio, 1.15; 95% CI 0.70-1.90; P = 0.57).
CONCLUSIONS: Hypomagnesemia is a novel predictor of ESRD in patients with type 2 diabetic nephropathy.
Yusuke Sakaguchi, Hirotsugu Iwatani, Takayuki Hamano, Kodo Tomida, Hiroaki Kawabata, Yasuo Kusunoki, Akihiro Shimomura, Isao Matsui, Terumasa Hayashi, Yoshiharu Tsubakihara, Yoshitaka Isaka, Hiromi Rakugi
Magnesium modifies the association between serum phosphate and the risk of progression to end-stage kidney disease in patients with non-diabetic chronic kidney disease.
Kidney Int. 2015 Oct;88(4):833-42. doi: 10.1038/ki.2015.165. Epub 2015 Jun 10.
Abstract/Text
It is known that magnesium antagonizes phosphate-induced apoptosis of vascular smooth muscle cells and prevents vascular calcification. Here we tested whether magnesium can also counteract other pathological conditions where phosphate toxicity is involved, such as progression of chronic kidney disease (CKD). We explored how the link between the risk of CKD progression and hyperphosphatemia is modified by magnesium status. A post hoc analysis was run in 311 non-diabetic CKD patients who were divided into four groups according to the median values of serum magnesium and phosphate. During a median follow-up of 44 months, 135 patients developed end-stage kidney disease (ESKD). After adjustment for relevant clinical factors, patients in the lower magnesium-higher phosphate group were at a 2.07-fold (95% CI: 1.23-3.48) risk for incident ESKD and had a significantly faster decline in estimated glomerular filtration rate compared with those in the higher magnesium-higher phosphate group. There were no significant differences in the risk of these renal outcomes among the higher magnesium-higher phosphate group and both lower phosphate groups. Incubation of tubular epithelial cells in high phosphate and low magnesium medium in vitro increased apoptosis and the expression levels of profibrotic and proinflammatory cytokine; these changes were significantly suppressed by increasing magnesium concentration. Thus, magnesium may act protectively against phosphate-induced kidney injury.
Yusuke Sakaguchi, Takayuki Hamano, Atsushi Wada, Junichi Hoshino, Ikuto Masakane
Magnesium and Risk of Hip Fracture among Patients Undergoing Hemodialysis.
J Am Soc Nephrol. 2018 Mar;29(3):991-999. doi: 10.1681/ASN.2017080849. Epub 2017 Nov 30.
Abstract/Text
Magnesium is an essential mineral for bone metabolism. However, little is known about the relationship between magnesium and the risk of fractures. In this cohort study, we elucidated the association between serum magnesium level and the risk of incident hip fracture among patients undergoing hemodialysis. We identified 113,683 patients undergoing hemodialysis with no history of hip fracture from a nation-wide database of patients undergoing dialysis in Japan. During a 2-year follow-up, a total of 2305 (2%) new hip fractures occurred. The crude incidence rate was significantly higher among patients in the lower quartiles of serum magnesium levels (2.63%, 2.08%, 1.76%, and 1.49% in Q1-Q4, respectively; P<0.001 for trend). The range of serum magnesium levels (in milligrams per deciliter) in each quartile was as follows: Q1, <2.3; Q2, 2.4-2.6; Q3, 2.7-2.8, and Q4, >2.9. After adjustment for demographic and clinical factors, patients in Q1 had a 1.23-fold higher risk for hip fracture than those in Q4 (95% confidence interval, 1.06 to 1.44; P<0.01). Similarly, an inverse probability weighting analysis showed an increased risk of hip fracture among patients in the lower magnesium quartiles. We did not observe significant effect modifications in subgroup analyses. The population-attributable fraction of serum magnesium level for incident hip fractures was 13.7% (95% confidence interval, 3.7% to 22.7%), which was much higher than that of serum calcium, serum phosphate, and parathyroid hormone levels. Thus, mild hypermagnesemia is associated with a lower risk of hip fracture among patients undergoing hemodialysis.
Copyright © 2018 by the American Society of Nephrology.
Maria Paz Escuela, Manuel Guerra, José M Añón, Vicente Martínez-Vizcaíno, María Dolores Zapatero, Angel García-Jalón, Sebastian Celaya
Total and ionized serum magnesium in critically ill patients.
Intensive Care Med. 2005 Jan;31(1):151-6. doi: 10.1007/s00134-004-2508-x. Epub 2004 Dec 17.
Abstract/Text
OBJECTIVE: To assess the alterations in total serum magnesium (tsMg) and ionized serum magnesium (Mg(2+)) and their association with prognosis in critically ill patients.
DESIGN AND SETTING: Prospective, cohort study in the intensive care unit (ICU) of a university teaching hospital.
PATIENTS: Adult patients admitted to the ICU without previous factors influencing magnesium homeostasis were included during a 6-month period.
MEASUREMENTS AND RESULTS: One hundred forty four patients were included. Mean age was 60.6+/-15.4 years; mean APACHE II score was 12.6+/-6.9. Blood samples were collected in the first 24 h after ICU admission and again on the second, third, and last days of stay in the ICU. At ICU admission 52.5% had total hypomagnesemia and 13.5% total hypermagnesemia; with respect to the Mg(2+) 9.7% showed ionized hypomagnesemia and 23.6% ionized hypermagnesemia. Patients who developed ionized hypermagnesemia had higher mortality than patients without ionized hypermagnesemia development (P=0.04). A moderate correlation between tsMg and Mg(2+) concentrations was found; however, a number of patients with total hypomagnesemia (69-85% during the study) had ionized normomagnesemia. The measure of agreement between tsMg and Mg(2+) levels was poor.
CONCLUSIONS: Magnesium alterations are frequently found in critically ill patients. The usually determined tsMg levels are not a reflection of Mg(2+) levels. Development of ionized hypermagnesemia is associated with prognosis.
M Elisaf, K Panteli, J Theodorou, K C Siamopoulos
Fractional excretion of magnesium in normal subjects and in patients with hypomagnesemia.
Magnes Res. 1997 Dec;10(4):315-20.
Abstract/Text
The aim of our study was the determination of fractional excretion of magnesium (FEMg++) in both normal subjects and hypomagnesemic patients. 142 subjects aged 26-72 years, recruited from our lipid clinic (control population) and 74 hypomagnesemic patients, aged 36-75 years, were studied. The mean FEMg++ in the control population was 1.8 per cent (range, 0.5-4 per cent). FEMg++ was not correlated with either serum magnesium or with serum creatinine. The mean FEMg++ in patients with hypomagnesemia of extrarenal origin was 1.4 per cent (range, 0.5-2.7 per cent), while the mean FEMg++ in hypomagnesemic patients in whom renal magnesium loss was the main etiologic factor for the pathogenesis of hypomagnesemia was 15 per cent (range, 4-48 per cent). In both groups of hypomagnesemic patients FEMg++ was positively correlated with the urinary magnesium to creatinine molar ratio, but was not correlated with serum magnesium or creatinine levels. FEMg++ could better distinguish the two groups of hypomagnesemic patients than the urinary magnesium to creatinine molar ratio. Hypomagnesemic patients exhibited a cluster of other acid-base and electrolyte abnormalities, mainly respiratory alkalosis, hypokalemia, hypophosphatemia, and hypocalcemia. In conclusion, in hypomagnesemic patients with normal renal function FEMg++ is a very useful tool for the diagnostic approach of hypomagnesemia. A value more than 4 per cent is indicative of inappropriate magnesium loss.
Nishitha Reddy, Jihnhee Yu, Marwan G Fakih
Toxicities and survival among octogenarians and nonagenarians with colorectal cancer treated with chemotherapy or concurrent chemoradiation therapy.
Clin Colorectal Cancer. 2007 Jan;6(5):362-6. doi: 10.3816/CCC.2007.n.005.
Abstract/Text
PURPOSE: Patients aged > or = 70 years with colon cancer benefit from chemotherapy, with no major added toxicities compared with a younger population. However, the safety and efficacy of chemotherapy or chemoradiation therapy in octogenarians and nonagenarians with colorectal cancer (CRC) has not been previously reported.
PATIENTS AND METHODS: We conducted a retrospective study of the safety and efficacy of chemotherapy or chemoradiation therapy in patients with CRC treated between January 2002 and June 2006 at Roswell Park Cancer Institute.
RESULTS: Thirty-three patients were identified, 24 of whom had colon cancer and 9 of whom had rectal cancer. Twenty-two patients with metastatic colon cancer and 8 patients with rectal cancer were evaluable for toxicity. All patients were started on an attenuated regimen of chemotherapy. A high rate of severe diarrhea (46%) and treatment-related hospitalizations (73%) were noted among patients with metastatic colon cancer. Toxicities were managed by treatment interruptions. The median overall survival among the metastatic colon cancer cohort was 20.6 months (95% confidence interval, 11.1-26.4 months). Among the patients with rectal cancer, 5 had locally advanced disease and were treated with chemoradiation therapy. Chemotherapy was interrupted in 3 of 5 patients because of toxicity. Radiation therapy was discontinued because of toxicity in 1 of 5 patients.
CONCLUSION: Our results suggest the susceptibility of patients with CRC aged > or = 80 years to chemotherapy toxicity. This age group should receive an attenuated dose of chemotherapy and be evaluated for dedicated clinical trials. Despite the high rate of treatment toxicity, selected octogenarians and nonagenarians with advanced CRC could benefit from chemotherapy, with overall survival neighboring that seen in younger populations.
I Cohen, A L Zimmerman
Changes in serum electrolyte levels during marathon running.
S Afr Med J. 1978 Mar 25;53(12):449-53.
Abstract/Text
Serum electrolytes were measured in 18 well-trained, experienced long-distance runners before and after a standard marathon run (42 km), during which they ingested no electrolytes. Their sweat losses and water deficits after completion of the marathon were also measured. In 12 of the subjects, the percentage change in plasma volume and in total circulating plasma electrolytes was determined. There was a highly significant fall in serum magnesium concentration, with an increase in both potassium and sodium levels. Changes in total circulating plasma sodium and chloride were closely correlated with alterations in plasma volume. On the basis of these observations, it is recommended that athletes drink an augmented volume of fluid during marathon running, irrespective of the prevailing weather conditions. Supplementation of potassium and magnesium is contraindicated during long-distance running. Salt intake is unnecessary during races over the standard marathon distance. Subjective evidence for glucose supplementation is presented.
Phuong-Chi T Pham, Phuong-Mai T Pham, Son V Pham, Jeffrey M Miller, Phuong-Thu T Pham
Hypomagnesemia in patients with type 2 diabetes.
Clin J Am Soc Nephrol. 2007 Mar;2(2):366-73. doi: 10.2215/CJN.02960906. Epub 2007 Jan 3.
Abstract/Text
Hypomagnesemia has been reported to occur at an increased frequency among patients with type 2 diabetes compared with their counterparts without diabetes. Despite numerous reports linking hypomagnesemia to chronic diabetic complications, attention to this issue is poor among clinicians. This article reviews the literature on the metabolism of magnesium, incidence of hypomagnesemia in patients with type 2 diabetes, implicated contributing factors, and associated complications. Hypomagnesemia occurs at an incidence of 13.5 to 47.7% among patients with type 2 diabetes. Poor dietary intake, autonomic dysfunction, altered insulin metabolism, glomerular hyperfiltration, osmotic diuresis, recurrent metabolic acidosis, hypophosphatemia, and hypokalemia may be contributory. Hypomagnesemia has been linked to poor glycemic control, coronary artery diseases, hypertension, diabetic retinopathy, nephropathy, neuropathy, and foot ulcerations. The increased incidence of hypomagnesemia among patients with type 2 diabetes presumably is multifactorial. Because current data suggest adverse outcomes in association with hypomagnesemia, it is prudent to monitor magnesium routinely in this patient population and treat the condition whenever possible.
Martin Epstein, Shaun McGrath, Florence Law
Proton-pump inhibitors and hypomagnesemic hypoparathyroidism.
N Engl J Med. 2006 Oct 26;355(17):1834-6. doi: 10.1056/NEJMc066308.
Abstract/Text
T Cundy, A Dissanayake
Severe hypomagnesaemia in long-term users of proton-pump inhibitors.
Clin Endocrinol (Oxf). 2008 Aug;69(2):338-41. doi: 10.1111/j.1365-2265.2008.03194.x. Epub 2008 Jan 23.
Abstract/Text
OBJECTIVE: To explore the mechanism underlying severe hypomagnesaemia in long-term users of proton-pump inhibitors (PPIs).
PATIENTS: Two cases of severe hypomagnesaemia in adult long-term users of the PPI omeprazole, presenting with hypocalcaemic seizures.
MEASUREMENTS: We studied renal magnesium handling during an incremental intravenous magnesium infusion, and assessed total body magnesium status by the 24-h retention of the parenteral load. We also observed the effects of oral magnesium supplements whilst continuing the PPI, and the effect of withdrawal of the PPI.
RESULTS: Both patients were severely magnesium-depleted and had avid renal magnesium retention, implicating a failure of intestinal magnesium absorption. There was no evidence of generalized malabsorption. The hypomagnesaemia could be partially corrected by high dose oral magnesium supplementation, and resolved on withdrawal of PPIs.
CONCLUSIONS: PPI use can inhibit active magnesium transport in the intestine, though it is not clear if this is an idiosyncratic effect. Long-term PPI users who are highly adherent to treatment can eventually deplete total body magnesium stores and present with severe complications of hypomagnesaemia.
Brenda C T Kieboom, Jessica C Kiefte-de Jong, Mark Eijgelsheim, Oscar H Franco, Ernst J Kuipers, Albert Hofman, Robert Zietse, Bruno H Stricker, Ewout J Hoorn
Proton pump inhibitors and hypomagnesemia in the general population: a population-based cohort study.
Am J Kidney Dis. 2015 Nov;66(5):775-82. doi: 10.1053/j.ajkd.2015.05.012. Epub 2015 Jun 26.
Abstract/Text
BACKGROUND: Proton pump inhibitor (PPI) use has been associated with hypomagnesemia in case reports and hospital-based cohort studies. Our objective was to determine whether PPI use is associated with hypomagnesemia in the general population and whether this is also found in histamine 2 receptor antagonist (H2RA) users.
STUDY DESIGN: Prospective cohort study.
SETTING & PARTICIPANTS: 9,818 individuals from the general population (Rotterdam Study).
PREDICTOR: PPI use and H2RA use compared to no use.
OUTCOMES & MEASUREMENTS: Serum magnesium and hypomagnesemia (serum magnesium ≤ 1.44 mEq/L). Analyses were adjusted for age, sex, body mass index, kidney function, comorbid conditions, and alcohol and diuretic use.
RESULTS: Serum magnesium level was 0.022 mEq/L lower in PPI users (n=724; 95% CI, -0.032 to -0.014 mEq/L) versus those with no use. PPI use was associated with increased risk of hypomagnesemia (n=36; OR, 2.00; 95% CI, 1.36-2.93) compared to no use. Effect modification was found between the use of PPIs and loop diuretics; in participants using loop diuretics (n=270), PPI use was associated with a further increased risk of hypomagnesemia (n=5; OR, 7.22; 95% CI, 1.69-30.83) compared to no use. The increased risk with PPIs was only seen after prolonged use (range, 182-2,618 days; OR, 2.99; 95% CI, 1.73-5.15). Including dietary magnesium intake into the model did not alter results (available for 2,504 participants, including 231 PPI users). H2RA users (n=250) also had a lower serum magnesium level (-0.016 [95% CI, -0.032 to -0.002] mEq/L) and increased risk of hypomagnesemia (n=12; OR, 2.00; 95% CI, 1.08-3.72) compared to those with no use, but no interaction with loop diuretics.
LIMITATIONS: Cross-sectional analysis with single serum magnesium measurement.
CONCLUSIONS: PPI use is associated with hypomagnesemia in the general population. Prolonged PPI use and concomitant loop diuretic use are associated with a stronger risk increase. Similar but weaker associations were found in H2RA users, except for interaction with loop diuretics.
Copyright © 2015 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
Akio Nakashima, Ichiro Ohkido, Keitaro Yokoyama, Aki Mafune, Mitsuyoshi Urashima, Takashi Yokoo
Proton Pump Inhibitor Use and Magnesium Concentrations in Hemodialysis Patients: A Cross-Sectional Study.
PLoS One. 2015;10(11):e0143656. doi: 10.1371/journal.pone.0143656. Epub 2015 Nov 30.
Abstract/Text
Magnesium concentration is a proven predictor of mortality in hemodialysis patients. Recent reports have indicated that proton pump inhibitor (PPI) use affects serum magnesium levels, however few studies have investigated the relationship between PPI use and magnesium levels in hemodialysis patients. This study aimed to clarify the association between PPI use and serum magnesium levels in hemodialysis patients. We designed this cross sectional study and included 1189 hemodialysis patients in stable condition. Associations between PPI and magnesium-related factors, as well as other possible confounders, were evaluated using a multiple regression model. We defined hypomagnesemia as a value < 2.0 mg/dL, and created comparable logistic regression models to assess the association between PPI use and hypomagnesemia. PPI use is associated with a significantly lower mean serum magnesium level than histamine 2 (H2) receptor antagonists or no acid-suppressive medications (mean [SD] PPI: 2.52 [0.45] mg/dL; H2 receptor antagonist: 2.68 [0.41] mg/dL; no acid suppressive medications: 2.68 [0.46] mg/dL; P = 0.001). Hypomagnesemia remained significantly associated with PPI (adjusted OR, OR: 2.05; 95% CI: 1.14-3.69; P = 0.017). PPI use is associated with an increased risk of hypomagnesemia in hemodialysis patients. Future prospective studies are needed to explore magnesium replacement in PPI users on hemodialysis.
