Hypomagnesemia Is a Risk Factor for Infections after Kidney Transplantation: A Retrospective Cohort Analysis

Abstract

Introduction: Magnesium (Mg2+) deficiency is a common finding in the early phase after kidney transplantation (KT) and has been linked to immune dysfunction and infections. Data on the association of hypomagnesemia and the rate of infections in kidney transplant recipients (KTRs) are sparse. Methods: We conducted a single-center retrospective cohort study of KTRs transplanted between 2005 and 2015. Laboratory data, including serum Mg2+ (median time of the Mg2+ measurement from KT: 29 days), rate of infections including mainly urinary tract infections (UTI), and common transplant-related viral infections (CMV, polyoma, EBV) in the early phase after KT were recorded. The primary outcome was the incidence of infections within one year after KT, while secondary outcomes were hospitalization due to infection, incidence rates of long-term (up to two years) infections, and all-cause mortality. Results: We enrolled 376 KTRs of whom 229 patients (60.9%) suffered from Mg2+ deficiency defined as a serum Mg2+ < 0.7 mmol/L. A significantly higher incidence rate of UTIs and viral infections was observed in patients with versus without Mg2+ deficiency during the first year after KT (58.5% vs. 47.6%, p = 0.039 and 69.9% vs. 51.7%, p < 0.001). After adjustment for potential confounders, serum Mg2+ deficiency remained an independent predictor of both UTIs and viral infections (odds ratio (OR): 1.73, 95% CI: 1.04–2.86, p = 0.035 and OR: 2.05, 95% CI: 1.23–3.41, p = 0.006). No group differences according to Mg2+ status in hospitalizations due to infections and infection incidence rates in the 12–24 months post-transplant were observed. In the Cox regression analysis, Mg2+ deficiency was not significantly associated with all-cause mortality (HR: 1.15, 95% CI: 0.70–1.89, p = 0.577). Conclusions: KTRs suffering from Mg2+ deficiency are at increased risk of UTIs and viral infections in the first year after KT. Interventional studies investigating the effect of Mg2+ supplementation on Mg2+ deficiency and viral infections in KTRs are needed.

The association of serum magnesium with infection in new-onset systemic lupus erythematosus patients

“…28 Previous clinical studies also demonstrated that hypomagnesemia was associated with an increased risk of infection in kidney transplantation patients. 7,8 In the present study, kidney function and gastrointestinal symptoms in the infection group were not significantly different from those in the noninfection group. The baseline serum magnesium level in the infection group of new-onset SLE patients was lower than that in the noninfection group.…”

“…5,6 In kidney transplantation patients, a lower baseline serum magnesium concentration is associated with an increased risk of infection. 7,8 Recently, a cross-sectional study indicated that higher dietary magnesium intake was associated with lower coronavirus disease 2019 (COVID-19) severity and related symptoms in hospitalized patients. 9 Another nationwide retrospective cohort study in the United States demonstrated that populations in low-magnesium areas were associated with a higher risk of early transmission in COVID-19 infection.…”

Incidence of Dysmagnesemia among Medically Hospitalized Patients and Associated Clinical Characteristics: A Prospective Cohort Study

“…Emerging data indicate a potential relationship between Mg and immune system functions. Mg is integral to various immune processes, including immunoglobulin creation, immune cell attachment, and antibody-driven cytolysis [ 23 ]. The current study demonstrated an association between hypomagnesemia and admission due to infectious diseases.…”

Non-Traditional Non-Immunological Risk Factors for Kidney Allograft Loss—Opinion

“…Magnesium deficit exhibits diabetogenic effects and it represents a proven independent risk factor for post-transplant diabetes mellitus [ 48 , 49 ]. Recent data also note the increased risk of Mg depleted patients to develop urinary tract infections and viral infections [ 50 ].…”