Hypomagnesemia as a predictor of mortality in hemodialysis patients and the role of proton pump inhibitors: A cross‐sectional, 1‐year, retrospective cohort study

Abstract

Introduction This study aimed to evaluate the association between proton pump inhibitor (PPI) use and serum magnesium levels, and the role of hypomagnesemia and PPI use as a risk factor for mortality in hemodialysis patients. Methods An observational study, including a cross-sectional and 1-year retrospective cohort study. The study comprised 399 hemodialysis patients at a single center, and was conducted from January to September 2014. Multiple linear regression analysis was used to investigate the independent relationship between serum magnesium levels and baseline demographic and clinical variables, including PPI and histamine-2 receptor antagonist use. Cox regression model was used to identify lower serum magnesium level and PPI as a predictor of 1-year mortality. Findings Serum magnesium levels were lower with PPI use than non-PPI use (2.39 ± 0.36 vs. 2.56 ± 0.39 mg/dL, P < 0.001). Multiple linear regression analysis showed that PPI use, low serum albumin levels, and low serum potassium and high-sensitivity C-reactive protein (hs-CRP) levels were significantly associated with low serum magnesium levels. A total of 29 deaths occurred during the follow-up period. According to Cox regression analysis stratified by hs-CRP, only high serum hs-CRP levels (>4.04 mg/L) in association with low serum magnesium levels was an independent risk factor for 1-year mortality (hazard ratio: 2.92; 95% CI: 1.53-6.40, P < 0.001). Discussion Serum magnesium levels are lower in PPI use. In the inflammatory state, a low serum magnesium level is a significant predictor of mortality in hemodialysis patients.

High serum magnesium levels are associated with favorable prognoses in diabetic hemodialysis patients, retrospective observational study

“…Indeed, hypocalcemia tends to coincide with hypomagnesemia, although no association was detected between s-Mg and VitD or intact PTH in this study. Regarding PPIs, previous investigations show they reduce Mg absorption in HD patients [28,29], and in our study, a significantly larger portion of patients in the Mg(L) group were oral PPI users.…”

Proton Pump Inhibitors, Histamine-2 Receptor Antagonists, and Hip Fracture Risk among Patients on Hemodialysis

“…Sakaguchi et al (40) recently conducted an analysis of data extracted from the Japanese Society for Dialysis Therapy Renal Data Registry that demonstrated clinical evidence for the influence of magnesium levels on parathyroid hormone secretion and fracture risk. Several studies report an association between PPI use and hypomagnesemia in the general population (41,42), and reduced magnesium levels have even been reported in multiple studies of patients dependent on hemodialysis (43)(44)(45)(46). Importantly, Kieboom et al noted similar associations with hypomagnesemia among both histamine-2 receptor antagonist users (adjusted OR, 2.00; 95% CI, 1.08 to 3.72) and PPI users (adjusted OR, 2.00; 95% CI, 1.36 to 2.93) (42).…”

Anion Gap as a Determinant of Ionized Fraction of Divalent Cations in Hemodialysis Patients

“…Despite the prognostic importance of Mg in patients undergoing hemodialysis (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14), little is known about ionized Mg in this population. One of the major findings of our study is that ionized Mg levels of patients on hemodialysis were mostly within the reference range, despite their abnormally high total Mg levels.…”

“…It is known that Ca promotes but Mg inhibits the progression of vascular calcification (1)(2)(3). In addition, abnormalities in the circulating levels of both Mg and Ca are independently associated with mortality in patients undergoing dialysis (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22).…”