Permanently reduced plasma ionized magnesium among renal transplant recipients on cyclosporine

Vannini, Simone; Mazzola, Brunello; Rodoni, L.; Truttmann, Anita C.; Wermuth, Bendicht; Bianchetti, Mario G.; Ferrari, Paolo

doi:10.1007/s001470050217

Cited by 18 publications

(9 citation statements)

References 18 publications

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“…Both hypomagnesemia [1][2][3]34] and NODAT [3,35] are common after transplantation. Insulin hyposecretion is essential in the pathophysiology of CNI-induced NODAT [35][36][37][38].…”

Section: Discussionmentioning

confidence: 99%

The effect of magnesium supplements on early post-transplantation glucose metabolism: a randomized controlled trial

et al. 2014

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SummaryPost-transplantation hypomagnesemia is common and predicts diabetes. Magnesium improves glycemic control in diabetics and insulin sensitivity in insulin resistant subjects. We aimed to assess the effectiveness of oral magnesium for improving glycemic control and insulin sensitivity at 3 months post-transplantation. We conducted a single-center, open-label, randomized parallel group study. We included adults with serum magnesium <1.7 mg/dl within 2 weeks after kidney transplantation. We randomized participants to 450 mg magnesium oxide up to three times daily or no treatment. The primary endpoint was the mean difference in fasting glycemia. Secondary endpoints were the mean difference in area under the curve (AUC) of glucose during an oral glucose tolerance test and insulin resistance measured by Homeostasis Model of Assessment-Insulin Resistance (HOMA-IR). Analyses were on intention-to-treat basis. In patients randomized to magnesium oxide (N = 27) versus no treatment (N = 27), fasting glycemia on average was 11.5 mg/dl lower (95% CI 1.7 to 21.3; P = 0.02). There was no difference between the two groups neither for 2 h AUC, where the mean value was 1164 mg/dl/min (95% CI À1884 to 4284; P = 0.45) lower in the treatment group nor for HOMA-IR. Magnesium supplements modestly improved fasting glycemia without effect on insulin resistance. Higher baseline glycemia among patients in the control group may have driven the positive outcome (ClinicalTrials.gov number: NCT01889576).

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“…Both hypomagnesemia [1][2][3]34] and NODAT [3,35] are common after transplantation. Insulin hyposecretion is essential in the pathophysiology of CNI-induced NODAT [35][36][37][38].…”

Section: Discussionmentioning

confidence: 99%

The effect of magnesium supplements on early post-transplantation glucose metabolism: a randomized controlled trial

et al. 2014

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“…Hypomagnesemia is a frequent complication in the early posttransplantation period and is particularly associated with the use of calcineurin inhibitors (CNI) (14). With regard to the association between hypomagnesemia and insulin resistance, a relationship between hypomagnesemia, immunosuppressive regimen and the occurrence of NODAT could be hypothesized in transplant recipients.…”

Section: Introductionmentioning

confidence: 99%

Posttransplantation Hypomagnesemia and Its Relation with Immunosuppression as Predictors of New-Onset Diabetes after Transplantation

Laecke

Biesen

Verbeke

et al. 2009

American Journal of Transplantation

120

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“…A recent study by our group has demonstrated that posttransplant hypomagnesemia is an independent risk factor for NODAT in the renal transplant population 6. Hypomagnesemia in renal transplant recipients (RTRs) is more common with tacrolimus‐based immunosuppressive regimens versus cyclosporine‐based ones7 but overall seems more connected to the use of calcineurin inhibitors (CNIs) 8. It is due mainly to drug‐induced renal magnesium (Mg) wasting, which occurs through transcriptional inhibition of the expression of the renal Mg transporter in the distal collecting tubule (transient receptor potential melastatin 6) 9…”

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confidence: 99%

Hypomagnesemia and the risk of new-onset diabetes after liver transplantation

et al. 2010

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New-onset diabetes after transplantation (NODAT) is a frequent complication after liver transplantation and has a negative impact on both patient and graft survival. In analogy with the previous finding of an association between posttransplant hypomagnesemia and NODAT in renal transplant recipients, the relation between both pretransplant and posttransplant hypomagnesemia and NODAT was studied in liver transplant recipients (LTRs). One hundred sixty-nine adult LTRs (>18 years old) without diabetes who underwent transplantation between 2004 and 2009 were studied (mean age ¼ 52.11 6 12.6 years, proportion of LTRs who were male ¼ 67.5%, body mass index ¼ 25.5 6 4.4 kg/m 2 , proportion receiving tacrolimus ¼ 90.0%). NODAT was defined according to the American Diabetes Association criteria. The association of NODAT with both pretransplant and posttransplant serum magnesium (Mg) was examined. Overall, 52 of 169 patients (30.8%) developed NODAT, and 57.7% of these (30 patients) were treated with antidiabetic drugs. Both pretransplant Mg levels and Mg levels in the first month after transplantation were lower in patients developing NODAT (P ¼ 0.008 and P ¼ 0.001, respectively). A multivariate regression model (adjusted for weight, pretransplant glucose levels, hyperglycemia in the first week after transplantation, gender, hepatitis C, and corticosteroid dosing) demonstrated both pretransplant Mg levels (hazard ratio ¼ 0.844 per 0.1 mg/dL increase, 95% confidence interval ¼ 0.764-0.932, P ¼ 0.001) and posttransplant Mg levels (hazard ratio ¼ 0.659, 95% confidence interval ¼ 0.518-0.838, P ¼ 0.001) to be independent predictors of NODAT together with age, biopsy-proven acute rejection, and cytomegalovirus (CMV) infection in the first year after transplantation. In conclusion, pretransplant hypomagnesemia and early posttransplant hypomagnesemia are independent predictors of new-onset diabetes after liver transplantation. New-onset diabetes after transplantation (NODAT) is a frequent complication after liver transplantation and develops in 10% to 30% of all patients according to the majority of studies [1][2][3] ; another 10% to 30% of patients already have diabetes before transplantation. 4 NODAT has a negative impact on both graft and patient survival and is related to chronic rejection and hepatic artery thrombosis. A recent study by our group has demonstrated that posttransplant hypomagnesemia is an independent risk factor for NODAT in the renal transplant population.6 Hypomagnesemia in renal transplant recipients (RTRs) is more common with tacrolimus-based immunosuppressive regimens versus cyclosporine-based ones 7 but overall seems more connected to the use of calcineurin inhibitors (CNIs).8 It is due mainly to

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Permanently reduced plasma ionized magnesium among renal transplant recipients on cyclosporine

Cited by 18 publications

References 18 publications

The effect of magnesium supplements on early post-transplantation glucose metabolism: a randomized controlled trial

The effect of magnesium supplements on early post-transplantation glucose metabolism: a randomized controlled trial

Posttransplantation Hypomagnesemia and Its Relation with Immunosuppression as Predictors of New-Onset Diabetes after Transplantation

Hypomagnesemia and the risk of new-onset diabetes after liver transplantation

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