52
|
Rosa-Diez G, Negri AL, Crucelegui MS, Philippi R, Perez-Teysseyre H, Sarabia-Reyes C, Loor-Navarrete H, Heguilen R. Sevelamer carbonate reduces the risk of hypomagnesemia in hemodialysis-requiring end-stage renal disease patients. Clin Kidney J 2016; 9:481-5. [PMID: 27274837 PMCID: PMC4886916 DOI: 10.1093/ckj/sfw021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 02/23/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Sevelamer has been associated with less progression of vascular calcifications. This effect could be due to a reduction in serum phosphate levels but also to other additive effects. Magnesium has been also shown to prevent vascular calcification but the effect of sevelamer on serum magnesium levels has not been thoroughly evaluated. Our aim was to analyze whether the use of sevelamer reduces the risk of hypomagnesemia in hemodialysis (HD)-requiring end-stage renal disease patients. METHODS All prevalent patients from the dialysis unit of the Hospital Italiano de Buenos Aires as of 1 June 2015 were evaluated. They were on three times per week bicarbonate/citrate-buffered HD. They were not receiving phosphate binders or magnesium-containing drugs. The average of three successive monthly magnesium serum levels was considered as the baseline magnesium concentration. Sevelamer carbonate use was retrieved from the patient's clinical records. RESULTS One hundred and fifty-one patients were included. A large proportion of individuals were on proton pump inhibitors (PPIs) (66%) and more than 50% were using sevelamer carbonate. Serum magnesium levels were significantly higher in those receiving sevelamer compared with those who did not (2.05 ± 0.3 versus 1.8 ± 0.4 mg/dL; P < 0.05). A larger proportion of individuals receiving sevelamer were among those with normal serum magnesium (P = 0.02), while among those with hypomagnesemia, a larger proportion were on PPIs. In the multivariate model including the use of PPIs, sevelamer carbonate resulted in an independent protective factor for hypomagnesemia (odds ratio: 0.44; 95% confidence interval: 0.21-0.87). CONCLUSIONS Hemodialysis patients receiving sevelamer show higher serum magnesium levels and a reduced risk of hypomagnesemia. This effect remains even after adjustment for PPI use. This effect could contribute to the still controversial superiority of sevelamer in preventing vascular calcifications.
Collapse
Affiliation(s)
- Guillermo Rosa-Diez
- Servicio de Nefrología , Hospital Italiano de Buenos Aires , Buenos Aires , Argentina
| | - Armando Luis Negri
- Instituto de Diagnostico e Investigaciones Metabólicas , Universidad del Salvador , Buenos Aires , Argentina
| | | | - Romina Philippi
- Servicio de Nefrología , Hospital Italiano de Buenos Aires , Buenos Aires , Argentina
| | | | - Carmen Sarabia-Reyes
- Servicio de Nefrología , Hospital Italiano de Buenos Aires , Buenos Aires , Argentina
| | - Henry Loor-Navarrete
- Servicio de Nefrología , Hospital Italiano de Buenos Aires , Buenos Aires , Argentina
| | - Ricardo Heguilen
- Servicio de Nefrología , Hospital Juan A. Fernández , Buenos Aires , Argentina
| |
Collapse
|
53
|
Kovesdy CP. Epidemiology of hyperkalemia: an update. Kidney Int Suppl (2011) 2016; 6:3-6. [PMID: 30675413 DOI: 10.1016/j.kisu.2016.01.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 01/05/2016] [Accepted: 01/05/2016] [Indexed: 01/13/2023] Open
Abstract
Hyperkalemia represents one of the most important acute electrolyte abnormalities, due to its potential for causing life-threatening arrhythmias. In individuals with normal kidney function hyperkalemia occurs relatively infrequently, but it can be much more common in patients who have certain predisposing conditions. Patients with chronic kidney disease are the most severely affected group, by virtue of their decreased ability to excrete potassium and because they commonly have additional predisposing conditions that often cluster within patients with chronic kidney disease. These conditions include comorbidities (e.g., diabetes mellitus) and the use of various medications, of which the most important are renin-angiotensin-aldosterone system inhibitors (RAASis). Hyperkalemia is associated with increased risk for all-cause mortality and for malignant arrhythmias such as ventricular fibrillation. The increased risk for adverse outcomes is observed even in serum potassium ranges that are often not considered targets for therapeutic interventions. The heightened risk of mortality associated with hyperkalemia is present in all patient populations, even those in whom hyperkalemia occurs otherwise rarely, such as individuals with normal kidney function.
Collapse
Affiliation(s)
- Csaba P Kovesdy
- University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Memphis Veterans Affairs Medical Center, Memphis, Tennessee, USA
| |
Collapse
|
54
|
de Roij van Zuijdewijn CLM, Grooteman MPC, Bots ML, Blankestijn PJ, Steppan S, Büchel J, Groenwold RHH, Brandenburg V, van den Dorpel MA, ter Wee PM, Nubé MJ, Vervloet MG. Serum Magnesium and Sudden Death in European Hemodialysis Patients. PLoS One 2015; 10:e0143104. [PMID: 26600017 PMCID: PMC4658157 DOI: 10.1371/journal.pone.0143104] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 10/30/2015] [Indexed: 12/18/2022] Open
Abstract
Despite suggestions that higher serum magnesium (Mg) levels are associated with improved outcome, the association with mortality in European hemodialysis (HD) patients has only scarcely been investigated. Furthermore, data on the association between serum Mg and sudden death in this patient group is limited. Therefore, we evaluated Mg in a post-hoc analysis using pooled data from the CONvective TRAnsport STudy (CONTRAST, NCT00205556), a randomized controlled trial (RCT) evaluating the survival risk in dialysis patients on hemodiafiltration (HDF) compared to HD with a mean follow-up of 3.1 years. Serum Mg was measured at baseline and 6, 12, 24 and 36 months thereafter. Cox proportional hazards models, adjusted for confounders using inverse probability weighting, were used to estimate hazard ratios (HRs) of baseline serum Mg on all-cause mortality, cardiovascular mortality, non-cardiovascular mortality and sudden death. A generalized linear mixed model was used to investigate Mg levels over time. Out of 714 randomized patients, a representative subset of 365 (51%) were analyzed in the present study. For every increase in baseline serum Mg of 0.1 mmol/L, the HR for all-cause mortality was 0.85 (95% CI 0.77–94), the HR for cardiovascular mortality 0.73 (95% CI 0.62–0.85) and for sudden death 0.76 (95% CI 0.62–0.93). These findings did not alter after extensive correction for potential confounders, including treatment modality. Importantly, no interaction was found between serum phosphate and serum Mg. Baseline serum Mg was not related to non-cardiovascular mortality. Mg decreased slightly but statistically significant over time (Δ -0.011 mmol/L/year, 95% CI -0.017 to -0.009, p = 0.03). In short, serum Mg has a strong, independent association with all-cause mortality, cardiovascular mortality and sudden death in European HD patients. Serum Mg levels decrease slightly over time.
Collapse
Affiliation(s)
- Camiel L. M. de Roij van Zuijdewijn
- Department of Nephrology, VU University Medical Center, Amsterdam, the Netherlands
- Institute for Cardiovascular Research, VU University Medical Center (ICaR-VU), VU University Medical Center, Amsterdam, the Netherlands
- * E-mail:
| | - Muriel P. C. Grooteman
- Department of Nephrology, VU University Medical Center, Amsterdam, the Netherlands
- Institute for Cardiovascular Research, VU University Medical Center (ICaR-VU), VU University Medical Center, Amsterdam, the Netherlands
| | - Michiel L. Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Peter J. Blankestijn
- Department of Nephrology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Sonja Steppan
- Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
| | - Janine Büchel
- Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
| | - Rolf H. H. Groenwold
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Vincent Brandenburg
- Department of Cardiology and Vascular Medicine, University Hospital Aachen, Aachen, Germany
| | | | - Piet M. ter Wee
- Department of Nephrology, VU University Medical Center, Amsterdam, the Netherlands
- Institute for Cardiovascular Research, VU University Medical Center (ICaR-VU), VU University Medical Center, Amsterdam, the Netherlands
| | - Menso J. Nubé
- Department of Nephrology, VU University Medical Center, Amsterdam, the Netherlands
- Institute for Cardiovascular Research, VU University Medical Center (ICaR-VU), VU University Medical Center, Amsterdam, the Netherlands
| | - Marc G. Vervloet
- Department of Nephrology, VU University Medical Center, Amsterdam, the Netherlands
- Institute for Cardiovascular Research, VU University Medical Center (ICaR-VU), VU University Medical Center, Amsterdam, the Netherlands
| |
Collapse
|