Hypomagnesemia and increased risk of new-onset diabetes mellitus after transplantation in pediatric renal transplant recipients

Hayes, Wesley; Boyle, Sheila; Carroll, Adrian; Böckenhauer, Detlef; Marks, Stephen D.

doi:10.1007/s00467-016-3571-6

Cited by 19 publications

(11 citation statements)

References 46 publications

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“…In this study, we found that children treated with CNI showed significantly lower serum magnesium levels and that they were significantly more likely to develop hypomagnesemia. This is in line with previous findings in children [ 31 , 32 , 33 , 34 ] and adults [ 21 ]. In adults and animal models, it was shown that hypomagnesemia is caused by renal magnesium wasting [ 20 , 21 , 35 ].…”

Section: Discussionsupporting

confidence: 94%

Longitudinal Study of the Role of Epidermal Growth Factor on the Fractional Excretion of Magnesium in Children: Effect of Calcineurin Inhibitors

et al. 2018

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Background: It was shown in animal models and adults that the epidermal growth factor (EGF) is involved in the pathophysiology of calcineurin inhibitor (CNI) induced renal magnesium loss. In children, however, the exact mechanism remains unclear, which was set as the purpose of the present study. Methods: Children with nephrotic syndrome and renal transplant children treated with CNI (n = 50) and non-CNI treated children (n = 46) were included in this study. Urine and serum samples were collected at three time points to determine magnesium, creatinine, and EGF. The magnesium intake was calculated from a food frequency questionnaire. Results: Serum Mg2+ and urinary EGF/creatinine were significantly lower in the CNI treated children, with significantly more CNI-treated children developing hypomagnesaemia. In the latter patients, the fractional excretion of magnesium (FE Mg2+) was significantly higher. Urinary EGF, age, renal function, and serum magnesium were independent predictors of the FE Mg2+. Only 29% of the children reached the recommended daily intake of magnesium. The magnesium intake did not differ between hypomagnesemic and normomagnesemic patients and was not a predictor of the FE Mg2+. Conclusions: In CNI-treated children who developed hypomagnesemia, the FE Mg2+ was increased. The urinary EGF concentration, age, and renal function are independent predictors of the FE Mg2+.

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Section: Discussionsupporting

confidence: 94%

Longitudinal Study of the Role of Epidermal Growth Factor on the Fractional Excretion of Magnesium in Children: Effect of Calcineurin Inhibitors

et al. 2018

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“…Hypomagnesemia and high tacrolimus levels were significant and independent risk factors for PTDM ( p = 0.01 and p < 0.001, respectively). No association between hypomagnesemia and tacrolimus levels was observed, suggesting that both risk factors were independent from each other [ 55 ]. Conversely, in a cohort study of 451 pediatric solid organ transplant recipients, Chanchlani et al failed to identify an association between hypomagnesemia and PTDM.…”

Section: Serum Magnesium and New-onset Diabetes Mellitus After Tramentioning

confidence: 99%

Serum Magnesium after Kidney Transplantation: A Systematic Review

et al. 2018

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Magnesium (Mg) status has recently drawn close attention in chronic kidney disease and in kidney transplant recipients. This review aims to evaluate the body of evidence linking hypomagnesemia to clinical consequences in these specific populations. After a brief summary of the main mechanisms involved in Mg regulation and of Mg status in end-stage renal disease, the review focuses on the relationship between hypomagnesemia and cardiovascular risk in kidney transplant recipients. A body of evidence in recent studies points to a negative impact of hypomagnesemia on post-transplant diabetes mellitus (PTDM) and cardiovascular risk, which currently represent the main threat for morbidity and mortality in kidney transplantation. Deleterious biological mechanisms induced by hypomagnesemia are also discussed. While data analysis enables us to conclude that hypomagnesemia is linked to the development of PTDM, studies prospectively evaluating the impact of hypomagnesemia correction after kidney transplantation are still lacking and needed.

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“…A retrospective analysis performed by Hayes and colleagues found low serum magnesium to be an independent risk factor for new‐onset diabetes among pediatric renal transplant recipients. An additional finding of this study showed that high tacrolimus trough concentrations conferred additional risk for development of new‐onset diabetes . Most concerning are reports of decreased allograft survival in renal transplant patients who have hypomagnesemia .…”

Section: Introductionmentioning

confidence: 63%

Efficacy and tolerability of magnesium plus protein for managing hypomagnesemia in pediatric kidney transplant patients

Lewis

Neely

Turman

2018

Pediatric Transplantation

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We sought to investigate whether magnesium oxide bound to soy protein (MGP) increases serum magnesium concentrations with less diarrhea compared to commonly prescribed magnesium salts. Subjects were switched to MGP at a near-equivalent daily elemental magnesium dose. Mean serum magnesium levels were compared. If magnesium levels remained <1.7 mg/dL after switching to MGP, subjects were enrolled into Part 2 and received a one-time MGP dose adjustment. The MGP daily dose was increased by 266 mg. For both parts 1 and 2, subjects recorded the number and quality of their stools to assess gastrointestinal (GI) tolerability of MGP. Twelve pediatric kidney transplant recipients completed Part 1. Mean serum magnesium levels increased from 1.61 (SD 0.1) on standard MG to 1.69 (SD 0.1); t(11) = 2.6, P = .02 on MGP. Five subjects completed Part 2, and all achieved serum magnesium ≥1.7 mg/dL (mean 1.75 mg/dL, SD 0.06; t(4) = 2.7, P = .06). Subjects reported the same number of, but looser bowel movements with MGP; however, individuals did not perceive intolerable GI symptoms with MGP therapy and all chose to remain on MGP at the end of the study. At an equivalent mg/kg/d dose of elemental magnesium, serum magnesium levels on MGP were significantly higher.

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Hypomagnesemia and increased risk of new-onset diabetes mellitus after transplantation in pediatric renal transplant recipients

Cited by 19 publications

References 46 publications

Longitudinal Study of the Role of Epidermal Growth Factor on the Fractional Excretion of Magnesium in Children: Effect of Calcineurin Inhibitors

Longitudinal Study of the Role of Epidermal Growth Factor on the Fractional Excretion of Magnesium in Children: Effect of Calcineurin Inhibitors

Serum Magnesium after Kidney Transplantation: A Systematic Review

Efficacy and tolerability of magnesium plus protein for managing hypomagnesemia in pediatric kidney transplant patients

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