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Hoca E, Arat EK, Arat O, Ahbab S, Kula AC, Öztürk H, Öztürk EÇ, Türker BÇ, Türker F, Ataoğlu HE. Hypermagnesemia is associated with poor outcomes during hospitalization. Ir J Med Sci 2024; 193:733-739. [PMID: 37684491 DOI: 10.1007/s11845-023-03518-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/04/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND Hypermagnesemia is one of the vital electrolyte disturbances and is associated with such chronic conditions as cardiovascular, endocrinologic, renal diseases, and malignancy. AIM This study evaluates the association between hypermagnesemia and clinical course in hospitalized patients. METHODS This study was conducted at the University of Health Sciences Haseki Training and Research Hospital Internal Medicine Clinic. We evaluated a total of 3850 patients. 2130 patients have met the inclusion criteria were included in the study. Those who were discharged with healing were evaluated as having a good prognosis. Patients who died or were transferred to the intensive care unit (ICU) were defined as having a poor prognosis. We divided the patients' serum magnesium levels into four quartiles and examined the clinical course/conditions of the patients. RESULTS Of 2130 patients, 1013 (51.9%) were female. The mean age of patients with poor prognoses (69.2 ± 14.9) was higher than those with good prognoses (59.7 ± 19.1). Hypermagnesemia (4th quartile) was detected in 61 (33.9%), and hypomagnesemia (1st quartile) was found in 42 (23.3%) patients out of 180 patients with poor clinical outcomes. It was statistically significant that hypermagnesemia was more common in patients with poor prognoses (p: 0.002). Chronic kidney disease (CKD) was diagnosed in 258 (53.3%) of 484 hypermagnesemia patients. Hypermagnesemia was found to be more common in patients with CKD, which was statistically significant (p: 0.003). CONCLUSIONS Hypermagnesemia is associated with poor prognosis independent of comorbidities. Besides hypomagnesemia, hypermagnesemia should be considered a critical electrolyte imbalance.
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Affiliation(s)
- Emre Hoca
- University of Health Sciences Turkey, Haseki Training and Research Hospital, Internal Medicine Clinic, Sultangazi, İstanbul, Turkey.
| | - Esra Kaplan Arat
- Kahramanmaraş Necip Fazıl City Hospital, Internal Medicine Clinic, Kahramanmaraş, Turkey
| | - Onur Arat
- Türkoğlu Dr Kemal Beyazıt State Hospital, Internal Medicine Clinic, Kahramanmaraş, Turkey
| | - Süleyman Ahbab
- University of Health Sciences Turkey, Haseki Training and Research Hospital, Internal Medicine Clinic, Sultangazi, İstanbul, Turkey
| | - Atay Can Kula
- Balıkesir İvrindi State Hospital, Internal Medicine Clinic, Balıkesir, Türkiye
| | - Hüseyin Öztürk
- Başakşehir Çam Ve Sakura City Hospital, Internal Medicine Clinic, Istanbul, Turkey
| | - Ece Çiftçi Öztürk
- University of Health Sciences Turkey, Haseki Training and Research Hospital, Internal Medicine Clinic, Sultangazi, İstanbul, Turkey
| | - Betül Çavuşoğlu Türker
- University of Health Sciences Turkey, Haseki Training and Research Hospital, Internal Medicine Clinic, Sultangazi, İstanbul, Turkey
| | - Fatih Türker
- University of Health Sciences Turkey, Haseki Training and Research Hospital, Internal Medicine Clinic, Sultangazi, İstanbul, Turkey
| | - Hayriye Esra Ataoğlu
- University of Health Sciences Turkey, Haseki Training and Research Hospital, Internal Medicine Clinic, Sultangazi, İstanbul, Turkey
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Chen JY, Jiang MY, Huang YT, Hwang JC. Lower product of magnesium × potassium is associated with higher mortality in chronic hemodialysis patients: a cohort study. Sci Rep 2023; 13:22128. [PMID: 38092856 PMCID: PMC10719325 DOI: 10.1038/s41598-023-49372-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 12/07/2023] [Indexed: 12/17/2023] Open
Abstract
This study aimed to investigate the Mg × K product on the mortality risk of hemodialysis patients with concomitant hypokalemia and lower magnesium levels. This was a prospective observational study of patients in a HD center in southern Taiwan. A total of 444 HD patients were divided into 5 groups by the Mg × K product: group 1, bottom quintile, median Mg × K: 7.87, IQR: 7.03-8.12 (n = 89, age: 64 ± 13 years old); group 2, median Mg × K: 9.37, IQR: 8.97-9.86 (n = 89, age:62 ± 13 years old); group 3, median Mg × K: 10.95, IQR: 10.50-11.26 (n = 89, age:64 ± 13 years old); group 4, median Mg × K: 12.30, IQR: 11.87-12.82 (n = 89, 61 ± 12 years old); and group 5, top quintile, median Mg × K: 14.92, IQR:14.07-16.23 (n = 88, 62 ± 11 years old). The patients were followed up for 2 years to determine the risk of all-cause mortality. Patients with a lower Mg × K product had more comorbidities, malnutrition-inflammation status, and a higher mortality risk. Using multivariable Cox regression analysis, a higher Mg × K [HR, 0.89; 95%CI (0.81-0.98)] was found to be an independent predictor of better survival. HD patients with a lower Mg × K product had more comorbidities, a marked malnutrition-inflammation status, and were associated with long-term mortality. A higher Mg × K value is a favorable survival factor.
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Affiliation(s)
- Jui-Yi Chen
- Division of Nephrology, Department of Internal Medicine, Chi Mei Medical Center, No. 901, Zhonghua Rd., Yongkang Dist., Tainan City, Taiwan
- Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Ming-Yan Jiang
- Division of Nephrology, Department of Internal Medicine, Chi Mei Medical Center, No. 901, Zhonghua Rd., Yongkang Dist., Tainan City, Taiwan
| | - Yun-Ting Huang
- Division of Nephrology, Department of Internal Medicine, Chi Mei Medical Center, No. 901, Zhonghua Rd., Yongkang Dist., Tainan City, Taiwan
| | - Jyh-Chang Hwang
- Division of Nephrology, Department of Internal Medicine, Chi Mei Medical Center, No. 901, Zhonghua Rd., Yongkang Dist., Tainan City, Taiwan.
- Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
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Aal-Hamad AH, Al-Alawi AM, Kashoub MS, Falhammar H. Hypermagnesemia in Clinical Practice. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1190. [PMID: 37512002 PMCID: PMC10384947 DOI: 10.3390/medicina59071190] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/20/2023] [Accepted: 06/21/2023] [Indexed: 07/30/2023]
Abstract
Hypermagnesemia is a relatively uncommon but potentially life-threatening electrolyte disturbance characterized by elevated magnesium concentrations in the blood. Magnesium is a crucial mineral involved in various physiological functions, such as neuromuscular conduction, cardiac excitability, vasomotor tone, insulin metabolism, and muscular contraction. Hypomagnesemia is a prevalent electrolyte disturbance that can lead to several neuromuscular, cardiac, or nervous system disorders. Hypermagnesemia has been associated with adverse clinical outcomes, particularly in hospitalized patients. Prompt identification and management of hypermagnesemia are crucial to prevent complications, such as respiratory and cardiovascular negative outcomes, neuromuscular dysfunction, and coma. Preventing hypermagnesemia is crucial, particularly in high-risk populations, such as patients with impaired renal function or those receiving magnesium-containing medications or supplements. Clinical management of hypermagnesemia involves discontinuing magnesium-containing therapies, intravenous fluid therapy, or dialysis in severe cases. Furthermore, healthcare providers should monitor serum magnesium concentration in patients at risk of hypermagnesemia and promptly intervene if the concentration exceeds the normal range.
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Affiliation(s)
- Aya Hasan Aal-Hamad
- Department of Emergency, Sultan Qaboos University Hospital, P.O. Box 141, Muscat 123, Oman
| | - Abdullah M Al-Alawi
- Department of Medicine, Sultan Qaboos University Hospital, P.O. Box 141, Muscat 123, Oman
- Internal Medicine Residency Training Program, Oman Medical Specialty Board, P.O. Box 1422, Al-Khoudh 132, Oman
| | - Masoud Salim Kashoub
- Department of Medicine, Sultan Qaboos University Hospital, P.O. Box 141, Muscat 123, Oman
- Internal Medicine Residency Training Program, Oman Medical Specialty Board, P.O. Box 1422, Al-Khoudh 132, Oman
| | - Henrik Falhammar
- Department of Endocrinology, QB85, Karolinska University Hospital, 17176 Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institute, 17177 Stockholm, Sweden
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Wang R, He M, Xu J. Initial Serum Magnesium Level Is Associated with Mortality Risk in Traumatic Brain Injury Patients. Nutrients 2022; 14:nu14194174. [PMID: 36235826 PMCID: PMC9570645 DOI: 10.3390/nu14194174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Electrolyte disorder is prevalent in traumatic brain injury (TBI) patients. This study is designed to explore the association between initial serum magnesium levels and mortality of TBI patients. METHODS TBI patients recorded in the Medical Information Mart for Intensive Care-III database were screened for this study. Logistic regression analysis was used to explore risk factors for mortality of included TBI patients. The restricted cubic spline (RCS) was applied to fit the correlation between initial serum magnesium level and mortality of TBI. RESULTS The 30-day mortality of included TBI patients was 17.0%. Patients with first-tertile and third-tertile serum magnesium levels had higher mortality than those of the second tertile. Univariate regression analysis showed that the serum magnesium level was not associated with mortality. Unadjusted RCS indicated the relationship between serum magnesium level mortality was U-shaped. After adjusting confounding effects, multivariate regression analysis presented that serum magnesium level was positively associated with mortality. CONCLUSION TBI patients with abnormally low or high levels of serum magnesium both have a higher incidence of mortality. At the same time, a higher initial serum magnesium level is independently associated with mortality in TBI patients. Physicians should pay attention to the clinical management of TBI patients, especially those with higher serum magnesium levels.
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Affiliation(s)
- Ruoran Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Min He
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
- Correspondence: (M.H.); (J.X.)
| | - Jianguo Xu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu 610041, China
- Correspondence: (M.H.); (J.X.)
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Association of magnesium abnormalities at intensive care unit admission with kidney outcomes and mortality: a prospective cohort study. Clin Exp Nephrol 2022; 26:997-1004. [PMID: 35760979 DOI: 10.1007/s10157-022-02245-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 06/02/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Magnesium abnormalities have been associated with adverse kidney outcomes and mortality in critically ill patients, however, this association remains inconsistent. This study aimed to investigate the association of magnesium abnormalities at intensive care unit (ICU) admission with kidney outcomes (i.e., acute kidney injury (AKI) and kidney function recovery) and mortality risk in a large cohort of critically ill patients. METHODS A prospective cohort study was conducted by collecting data from three ICUs in Brazil. The ICU admission serum magnesium level was used to define hypomagnesemia (< 1.60 mg/dL) and hypermagnesemia (> 2.40 mg/dL). The Kidney Disease Improving Global Outcomes AKI Guideline was used to define AKI based on serum creatinine levels. Kidney function recovery was defined as full recovery, partial recovery, and non-recovery at ICU discharge. Mortality was screened up to 28 days during ICU stay. RESULTS A total of 7,042 patients was analyzed, hypomagnesemia was found in 18.4% (n = 1,299) and hypermagnesemia in 4.4% (n = 311). Patients with hypomagnesemia were 25% more likely to develop AKI after adjustment for confounding variables (OR = 1.25; 95% CI 1.08-1.46). No significant association was found for hypermagnesemia and AKI (OR = 1.18; 95% CI 0.89-1.57). Kidney function recovery was similar among groups but hypermagnesemia had lower non-recovery rates. Both hypomagnesemia and hypermagnesemia were associated with 65 and 52% higher mortality risk after adjustments for confounders, respectively (HR = 1.65; 95% CI 1.32-2.06 and 1.52; 95% CI 1.01-2.29). CONCLUSIONS Hypomagnesemia, but not hypermagnesemia, at ICU admission was associated with AKI development. On the other hand, both hypomagnesemia and hypermagnesemia were associated with higher mortality risks.
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Morooka H, Tanaka A, Kasugai D, Ozaki M, Numaguchi A, Maruyama S. Abnormal magnesium levels and their impact on death and acute kidney injury in critically ill children. Pediatr Nephrol 2022; 37:1157-1165. [PMID: 34704113 DOI: 10.1007/s00467-021-05331-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 09/26/2021] [Accepted: 09/27/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND The prevalence of magnesium imbalance in critically ill children is very high. However, its significance in the development of acute kidney injury (AKI) and mortality remains unknown. METHODS In this retrospective observational study from 2010 to 2018, the pediatric-specific intensive care database was analyzed. We included critically ill children aged > 3 months and those without chronic kidney disease. Patients were diagnosed with AKI, according to the Kidney Disease Improving Global Outcomes (KDIGO) study. We calculated the initial corrected magnesium levels (cMg) within 24 h and used a spline regression model to evaluate the cut-off values for cMg. We analyzed 28-day mortality and its association with AKI. The interaction between AKI and magnesium imbalance was evaluated. RESULTS The study included 3,669 children, of whom 105 died within 28 days, while 1,823 were diagnosed with AKI. The cut-off values for cMg were 0.72 and 0.94 mmol/L. Both hypermagnesemia and hypomagnesemia were associated with 28-day mortality (odds ratio [OR] = 2.99, 95% confidence interval [CI] = 1.89-4.71, p < 0.001; OR = 2.80, 95% CI = 1.60-4.89, p < 0.001). Hypermagnesemia was associated with AKI (OR = 1.52, 95% CI = 1.27-1.82, p < 0.001), while neither hypermagnesemia nor hypomagnesemia interacted with the AKI stage on the 28-day mortality. CONCLUSIONS Abnormal magnesium levels were associated with 28-day mortality in critically ill children. AKI and hypermagnesemia had a strong association. "A higher resolution version of the Graphical abstract is available as Supplementary information".
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Affiliation(s)
- Hikaru Morooka
- Department of Nephrology, Nagoya University Hospital, Tsurumaicho, 65, Showa Ward, Nagoya, Aichi, Japan.,Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Akihito Tanaka
- Department of Nephrology, Nagoya University Hospital, Tsurumaicho, 65, Showa Ward, Nagoya, Aichi, Japan.
| | - Daisuke Kasugai
- Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masayuki Ozaki
- Department of Emergency and Critical Care Medicine, Komaki City Hospital, Komaki, Aichi, Japan
| | - Atsushi Numaguchi
- Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Shoichi Maruyama
- Division of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Hypermagnesaemia, but Not Hypomagnesaemia, Is a Predictor of Inpatient Mortality in Critically Ill Children with Sepsis. DISEASE MARKERS 2022; 2022:3893653. [PMID: 35126786 PMCID: PMC8814719 DOI: 10.1155/2022/3893653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 11/25/2021] [Accepted: 01/05/2022] [Indexed: 12/20/2022]
Abstract
Objective The effect of serum magnesium on the prognosis of children with sepsis in the pediatric intensive care unit (PICU) is unclear. This study was designed to assess the risk of inpatient mortality for children with sepsis in the PICU based on serum magnesium levels at admission. Methods We collected patients' clinical information from the Pediatric Intensive Care database and then performed locally weighted scatterplot smoothing (LOWESS) analysis, Kaplan–Meier analysis, and multivariate logistic regression to determine the relationship between admission serum magnesium and inpatient mortality in children with sepsis. Results A total of 974 critically ill children with sepsis were included, with 246 patients in the hypomagnesemia group, 666 in the normal group, and 62 in the hypermagnesemia group. The chi-square test suggested that the hypermagnesemia group had higher in-hospital mortality than the normal group (14.5% vs. 2.4%, P < 0.001). Kaplan–Meier curves revealed that the 30-day overall survival rate was lower in the hypermagnesaemia group than in the normal group (P < 0.001). The multivariate logistic regression model revealed that hypermagnesaemia was a risk factor related to inpatient mortality (odds ratio 4.22, 95% CI 1.55-11.50), while hypomagnesaemia was not a significant factor for inpatient mortality (odds ratio 0.78, 95% CI 0.26-2.32). Conclusion Hypermagnesaemia, but not hypomagnesaemia, is a predictor of inpatient mortality in critically ill children with sepsis.
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Machine Learning Consensus Clustering Approach for Hospitalized Patients with Dysmagnesemia. Diagnostics (Basel) 2021; 11:diagnostics11112119. [PMID: 34829467 PMCID: PMC8619519 DOI: 10.3390/diagnostics11112119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/12/2021] [Accepted: 11/13/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The objectives of this study were to classify patients with serum magnesium derangement on hospital admission into clusters using unsupervised machine learning approach and to evaluate the mortality risks among these distinct clusters. METHODS Consensus cluster analysis was performed based on demographic information, principal diagnoses, comorbidities, and laboratory data in hypomagnesemia (serum magnesium ≤ 1.6 mg/dL) and hypermagnesemia cohorts (serum magnesium ≥ 2.4 mg/dL). Each cluster's key features were determined using the standardized mean difference. The associations of the clusters with hospital mortality and one-year mortality were assessed. RESULTS In hypomagnesemia cohort (n = 13,320), consensus cluster analysis identified three clusters. Cluster 1 patients had the highest comorbidity burden and lowest serum magnesium. Cluster 2 patients had the youngest age, lowest comorbidity burden, and highest kidney function. Cluster 3 patients had the oldest age and lowest kidney function. Cluster 1 and cluster 3 were associated with higher hospital and one-year mortality compared to cluster 2. In hypermagnesemia cohort (n = 4671), the analysis identified two clusters. Compared to cluster 1, the key features of cluster 2 included older age, higher comorbidity burden, more hospital admissions primarily due to kidney disease, more acute kidney injury, and lower kidney function. Compared to cluster 1, cluster 2 was associated with higher hospital mortality and one-year mortality. CONCLUSION Our cluster analysis identified clinically distinct phenotypes with differing mortality risks in hospitalized patients with dysmagnesemia. Future studies are required to assess the application of this ML consensus clustering approach to care for hospitalized patients with dysmagnesemia.
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Nalesso F, Garzotto F, Cattarin L, Innico G, Gobbi L, Calò LA. Impact of different hemodiafiltration solutions on ionemia in long-term CRRT. Int J Artif Organs 2021; 44:807-815. [PMID: 34472996 DOI: 10.1177/03913988211043203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Critical patients with Acute Kidney Injury (AKI) requiring renal replacement therapy are in most cases eligible only for continuous modalities where the electrolyte balance control is a critical issue. The standard solutions used for hemodiafiltration, containing potassium at 2 mmol/L and no phosphorus, determines during the extended renal replacement therapy hypokalemia and hypophosphatemia. Therefore, solutions containing potassium and phosphate in physiological concentrations were formulated to avoid electrolyte imbalances and reduce ion alterations in prolonged treatments, these solutions are not routinely used in the standard clinical practice. To avoid electrolyte imbalances, we have first introduced in our practice two different solutions and then we have retrospectively analyzed the electrolyte balance upon these two solutions in order to identity the impact of these solutions on potassium and phosphate according to our clinical practice. We retrospectively analyzed 96 patients treated with Continuous Renal Replacement Therapy (CRRT) in the intensive care units (ICU) at Padua's University Hospital to evaluate the role on electrolyte balance of Phoxilium® and Prismasol 2® that differ in their composition and the need for electrolytes infusions. In the Phoxilium group the frequency of hypokalemia, hypophosphatemia, and the need of potassium and phosphate replacement were significantly reduced resulting in a reduction in complications, workload, and clinical risk associated with infusions of electrolytes. Our data demonstrated that the use of these two different hemodiafiltration solutions can reduce the occurrence of hypokalemia and hypophosphatemia during CRRT performing personalized treatments without the use of potassium and phosphate infusions.
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Affiliation(s)
- Federico Nalesso
- Department of Medicine, Nephrology, University of Padua, Padua, Italy
| | | | - Leda Cattarin
- Department of Medicine, Nephrology, University of Padua, Padua, Italy
| | - Georgie Innico
- Department of Medicine, Nephrology, University of Padua, Padua, Italy
| | - Laura Gobbi
- Department of Medicine, Nephrology, University of Padua, Padua, Italy
| | - Lorenzo A Calò
- Department of Medicine, Nephrology, University of Padua, Padua, Italy
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Galán Carrillo I, Vega A, Goicoechea M, Shabaka A, Gatius S, Abad S, López-Gómez JM. Impact of Serum Magnesium Levels on Kidney and Cardiovascular Prognosis and Mortality in CKD Patients. J Ren Nutr 2021; 31:494-502. [DOI: 10.1053/j.jrn.2020.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 09/14/2020] [Accepted: 09/23/2020] [Indexed: 02/03/2023] Open
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Zhao R, Cao J, Yang X, Zhang Q, Iqbal MZ, Lu J, Kong X. Inorganic material based macrophage regulation for cancer therapy: basic concepts and recent advances. Biomater Sci 2021; 9:4568-4590. [PMID: 34113942 DOI: 10.1039/d1bm00508a] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Macrophages with the M1 phenotype are a type of immune cell with exciting prospects for cancer therapy; however, when these macrophages infiltrate into tumours, many of them are induced by the tumour microenvironment to transform into the M2 type, which can enable tumour defence against external therapeutic strategies, assisting in tumour development. Macrophages have strong plasticity and functional heterogeneity, and their phenotypic transformation is complex and still poorly understood in relation to cancer therapy. Recent material advances in inorganic nanomaterials, especially inorganic elements in vivo, have accelerated the development of macrophage regulation-based cancer treatments. This review summarizes the basics of recent research on macrophage phenotype transformation and discusses the current challenges in macrophage type regulation. Then, the current achievements involving inorganic material-based macrophage regulation and the related anticancer effects of induced macrophages and their extracellular secretions are reviewed systematically. Importantly, inorganic nanomaterial-based macrophage phenotype regulation is flexible and can be adapted for different types of cancer therapies, presenting a possible novel approach for the generation of immune materials for cancer therapy.
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Affiliation(s)
- Ruibo Zhao
- Institute of Smart Biomaterials, School of Materials Science and Engineering, Zhejiang Sci-Tech University, Hangzhou 310018, Zhejiang, China. and Zhejiang-Mauritius Joint Research Center for Biomaterials and Tissue Engineering, Zhejiang Sci-Tech University, Hangzhou 310018, Zhejiang, China
| | - Jinping Cao
- Institute of Smart Biomaterials, School of Materials Science and Engineering, Zhejiang Sci-Tech University, Hangzhou 310018, Zhejiang, China. and Zhejiang-Mauritius Joint Research Center for Biomaterials and Tissue Engineering, Zhejiang Sci-Tech University, Hangzhou 310018, Zhejiang, China
| | - Xinyan Yang
- School of Bioengineering, Hangzhou Medical College, Hangzhou 310013, Zhejiang, China
| | - Quan Zhang
- Institute of Smart Biomaterials, School of Materials Science and Engineering, Zhejiang Sci-Tech University, Hangzhou 310018, Zhejiang, China. and Zhejiang-Mauritius Joint Research Center for Biomaterials and Tissue Engineering, Zhejiang Sci-Tech University, Hangzhou 310018, Zhejiang, China
| | - Muhammad Zubair Iqbal
- Institute of Smart Biomaterials, School of Materials Science and Engineering, Zhejiang Sci-Tech University, Hangzhou 310018, Zhejiang, China. and Zhejiang-Mauritius Joint Research Center for Biomaterials and Tissue Engineering, Zhejiang Sci-Tech University, Hangzhou 310018, Zhejiang, China
| | - Jiaju Lu
- Institute of Smart Biomaterials, School of Materials Science and Engineering, Zhejiang Sci-Tech University, Hangzhou 310018, Zhejiang, China. and Zhejiang-Mauritius Joint Research Center for Biomaterials and Tissue Engineering, Zhejiang Sci-Tech University, Hangzhou 310018, Zhejiang, China
| | - Xiangdong Kong
- Institute of Smart Biomaterials, School of Materials Science and Engineering, Zhejiang Sci-Tech University, Hangzhou 310018, Zhejiang, China. and Zhejiang-Mauritius Joint Research Center for Biomaterials and Tissue Engineering, Zhejiang Sci-Tech University, Hangzhou 310018, Zhejiang, China
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Mizuguchi Y, Konishi T, Nagai T, Sato T, Takenaka S, Tada A, Kobayashi Y, Komoriyama H, Kato Y, Omote K, Sato T, Kamiya K, Tsujinaga S, Iwano H, Kikuchi K, Tanaka S, Anzai T. Prognostic value of admission serum magnesium in acute myocardial infarction complicated by malignant ventricular arrhythmias. Am J Emerg Med 2021; 44:100-105. [PMID: 33582610 DOI: 10.1016/j.ajem.2021.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 01/06/2021] [Accepted: 02/01/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Although electrolyte abnormalities are related to worse clinical outcomes in patients with acute myocardial infarction (AMI), little is known about the association between admission serum magnesium level and adverse events in AMI patients complicated by out-of-hospital cardiac arrest presenting with malignant ventricular arrhythmias (OHCA-MVA). We investigated the prognostic value of serum magnesium level on admission in these patients. METHODS We retrospectively analyzed the data of 165 consecutive reperfused AMI patients complicated with OHCA-MVA between April 2007 and February 2020 in our university hospital. Serum magnesium concentration was measured on admission. The primary outcome was in-hospital death. RESULTS Fifty-four patients (33%) died during hospitalization. Higher serum magnesium level was significantly related to in-hospital death (Fine & Gray's test; p < 0.001). In multivariable logistic regression analyses, serum magnesium level on admission was independently associated with in-hospital death (hazard ratio 2.68, 95% confidence interval 1.24-5.80) even after adjustment for covariates. Furthermore, the incidences of cardiogenic shock necessitating an intra-aortic balloon pump (p = 0.005) or extracorporeal membrane oxygenation (p < 0.001), tracheal intubation (p < 0.001) and persistent vegetative state (p = 0.002) were significantly higher in patients with higher serum magnesium level than in those with lower serum magnesium level. CONCLUSIONS In reperfused AMI patients complicated by OHCA-MVA, admission serum magnesium level might be a potential surrogate marker for predicting in-hospital death.
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Affiliation(s)
- Yoshifumi Mizuguchi
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Takao Konishi
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Toshiyuki Nagai
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
| | - Tomoya Sato
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Sakae Takenaka
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Atsushi Tada
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yuta Kobayashi
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hirokazu Komoriyama
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yoshiya Kato
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kazunori Omote
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Takuma Sato
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kiwamu Kamiya
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shingo Tsujinaga
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroyuki Iwano
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kenjiro Kikuchi
- Department of Cardiology, Minami-ichijo Hospital, Sapporo, Japan
| | - Shinya Tanaka
- Department of Cancer Pathology, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Lin Z, Shen D, Zhou W, Zheng Y, Kong T, Liu X, Wu S, Chu PK, Zhao Y, Wu J, Cheung KM, Yeung KW. Regulation of extracellular bioactive cations in bone tissue microenvironment induces favorable osteoimmune conditions to accelerate in situ bone regeneration. Bioact Mater 2021; 6:2315-2330. [PMID: 33553818 PMCID: PMC7840811 DOI: 10.1016/j.bioactmat.2021.01.018] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/14/2021] [Accepted: 01/16/2021] [Indexed: 12/25/2022] Open
Abstract
The design of orthopedic biomaterials has gradually shifted from “immune-friendly” to “immunomodulatory,” in which the biomaterials are able to modulate the inflammatory response via macrophage polarization in a local immune microenvironment that favors osteogenesis and implant-to-bone osseointegration. Despite the well-known effects of bioactive metallic ions on osteogenesis, how extracellular metallic ions manipulate immune cells in bone tissue microenvironments toward osteogenesis and subsequent bone formation has rarely been studied. Herein, we investigate the osteoimmunomodulatory effect of an extracellular bioactive cation (Mg2+) in the bone tissue microenvironment using custom-made poly lactic-co-glycolic acid (PLGA)/MgO-alendronate microspheres that endow controllable release of magnesium ions. The results suggest that the Mg2+-controlled tissue microenvironment can effectively induce macrophage polarization from the M0 to M2 phenotype via the enhancement of anti-inflammatory (IL-10) and pro-osteogenic (BMP-2 and TGF-β1) cytokines production. It also generates a favorable osteoimmune microenvironment that facilitates the proliferation and osteogenic differentiation of bone marrow mesenchymal stem cells. The in vivo results further verify that a large amount of bony tissue, with comparable bone mineral density and mechanical properties, has been generated at an early post-surgical stage in rat intramedullary bone defect models. This study demonstrates that the concept of in situ immunomodulated osteogenesis can be realized in a controlled magnesium tissue microenvironment. Controlled release of Mg2+ was achieved by the microfluidic electrosprayed PLGA/MgO-alendronate microspheres. PLGA/MgO-alendronate microspheres with satisfied osteoimmunomodulatory properties accelerated bone regeneration in vivo. Extracellular Mg2+ induced macrophage switch to M2 phenotype with enhanced expressions of IL-10, BMP-2 and TGF-β1. Osteoimmune microenvironment favourably upregulated the osteogenic expressions of BMSCs.
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Affiliation(s)
- Zhengjie Lin
- College of Chemistry and Environmental Engineering, Shenzhen University, Shenzhen, 518060, China
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing, 210096, China
- Corresponding author. College of Chemistry and Environmental Engineering, Shenzhen University, China.
| | - Danni Shen
- Department of Materials Science and Engineering, College of Engineering, Peking University, Beijing, 100871, China
- Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, The University of Hong Kong Shenzhen Hospital, 1 Haiyuan 1st Road, Futian District, Shenzhen, China
| | - Weixiao Zhou
- Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Department of Biomedical Engineering, School of Medicine, Shenzhen University, Shenzhen, 518060, China
| | - Yufeng Zheng
- Department of Materials Science and Engineering, College of Engineering, Peking University, Beijing, 100871, China
| | - Tiantian Kong
- Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Department of Biomedical Engineering, School of Medicine, Shenzhen University, Shenzhen, 518060, China
| | - Xuanyong Liu
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai, 200050, China
| | - Shuilin Wu
- School of Materials Science & Engineering, the Key Laboratory of Advanced Ceramics and Machining Technology by the Ministry of Education of China, Tianjin University, Tianjin, 300072, China
| | - Paul K. Chu
- Department of Physics, Department of Materials Science and Engineering, City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong, China
| | - Ying Zhao
- Centre for Human Tissues and Organs Degeneration, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Jun Wu
- Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, The University of Hong Kong Shenzhen Hospital, 1 Haiyuan 1st Road, Futian District, Shenzhen, China
| | - Kenneth M.C. Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - Kelvin W.K. Yeung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
- Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, The University of Hong Kong Shenzhen Hospital, 1 Haiyuan 1st Road, Futian District, Shenzhen, China
- Corresponding author. Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China.
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14
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Pagano P, Marra A, Shinabarger D, Pillar C. In vitro activity of omadacycline and levofloxacin against Escherichia coli, Klebsiella pneumoniae and Staphylococcus saprophyticus in human urine supplemented with calcium and magnesium. J Antimicrob Chemother 2020; 75:2160-2163. [PMID: 32428235 PMCID: PMC7366199 DOI: 10.1093/jac/dkaa138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/16/2020] [Accepted: 03/18/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Omadacycline, an aminomethylcycline, was approved in 2018 for the treatment of acute bacterial skin and skin structure infections and community-acquired bacterial pneumonia. In a Phase Ib study, around 34% of the absorbed dose of omadacycline was shown to be excreted in urine-an important property for urinary tract infection (UTI) treatment. Therefore, omadacycline has been studied in two Phase II trials for the treatment of uncomplicated UTIs and acute pyelonephritis. The activity of omadacycline against UTI pathogens in human urine is important to understand in this context. OBJECTIVES To study the in vitro activity of omadacycline against UTI pathogens in human urine supplemented with calcium and magnesium. METHODS Omadacycline activity was compared with that of levofloxacin against the urinary pathogens Escherichia coli, Klebsiella pneumoniae and Staphylococcus saprophyticus in standard medium, pooled normal human urine and neutral pH-adjusted pooled normal human urine spiked with calcium or magnesium at concentrations consistent with hypercalcaemia and hypermagnesaemia. RESULTS The activities of omadacycline and levofloxacin against these urinary pathogens were lower in urine relative to standard medium; addition of Mg2+ to broth and urine had a further negative impact on omadacycline activity, whereas the addition of Ca2+ had less of an impact. Levofloxacin activity was not substantially reduced in either broth or urine by the addition of divalent cations. CONCLUSIONS The activity of omadacycline against UTI organisms was lower in urine relative to standard medium and was negatively impacted by magnesium. Omadacycline displayed slightly reduced activity when excess calcium was present, but, overall, the differences were ≤2-fold. These observations should be considered along with the pharmacokinetics of the agent for clinical context.
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15
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Malinowska J, Małecka M, Ciepiela O. Variations in Magnesium Concentration Are Associated with Increased Mortality: Study in an Unselected Population of Hospitalized Patients. Nutrients 2020; 12:nu12061836. [PMID: 32575600 PMCID: PMC7353204 DOI: 10.3390/nu12061836] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 01/10/2023] Open
Abstract
Dysmagnesemia is a serious disturbance of microelement homeostasis. The aim of this study was to analyze the distribution of serum magnesium concentrations in hospitalized patients according to gender, age, and result of hospitalization. The study was conducted from February 2018 to January 2019 at the Central Clinical Hospital in Warsaw. Laboratory test results from 20,438 patients were included in this retrospective analysis. When a lower reference value 0.65 mmol/L was applied, hypermagnesemia occurred in 196 patients (1%), hypomagnesemia in 1505 patients (7%), and normomagnesemia in 18,711 patients (92%). At a lower reference value of 0.75 mmol/L, hypomagnesemia was found in 25% and normomagnesemia in 74% of patients. At a lower reference value of 0.85 mmol/L, hypomagnesemia was found in 60% and normomagnesemia in 39% of patients. Either hypo- or hyper-magnesemia was associated with increased risk of in-hospital mortality. This risk is the highest in patients with hypermagnesemia (40.1% of deaths), but also increases inversely with magnesium concentration below 0.85 mmol/L. Serum magnesium concentration was not gender-dependent, and there was a slight positive correlation with age (p < 0.0001, r = 0.07). Large fluctuations in serum magnesium level were associated with increased mortality (p = 0.0017). The results indicate that dysmagnesemia is associated with severe diseases and generally severe conditions. To avoid misdiagnosis, an increase of a lower cut-off for serum magnesium concentration to at least 0.75 mmol/L is suggested.
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Affiliation(s)
- Justyna Malinowska
- Students Scientific Group of Laboratory Medicine, Medical University of Warsaw, 02-097 Warsaw, Poland;
| | - Milena Małecka
- Department of Laboratory Medicine, Medical University of Warsaw, 02-097 Warsaw, Poland;
| | - Olga Ciepiela
- Department of Laboratory Medicine, Medical University of Warsaw, 02-097 Warsaw, Poland;
- Correspondence: ; Tel.: +48-22-599-24-05
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16
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Sun L, Li X, Xu M, Yang F, Wang W, Niu X. In vitro immunomodulation of magnesium on monocytic cell toward anti-inflammatory macrophages. Regen Biomater 2020; 7:391-401. [PMID: 32793384 PMCID: PMC7415003 DOI: 10.1093/rb/rbaa010] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 02/12/2020] [Accepted: 02/22/2020] [Indexed: 12/20/2022] Open
Abstract
Biodegradable magnesium (Mg) has shown great potential advantages over current bone fixation devices and vascular scaffold technologies; however, there are few reports on the immunomodulation of corrosive Mg products, the micron-sized Mg particles (MgMPs). Human monocytic leukemia cell line THP-1 was set as the in vitro cell model to estimate the immunomodulation of MgMPs on cell proliferation, apoptosis, polarization and inflammatory reaction. Our results indicated high-concentration of Mg2+ demoted the proliferation of the THP-1 cells and, especially, THP-1-derived macrophages, which was a potential factor that could affect cell function, but meanwhile, cell apoptosis was almost not affected by Mg2+. In particular, the inflammation regulatory effects of MgMPs were investigated. Macrophages exposed to Mg2+ exhibited down-regulated expressions of M1 subtype markers and secretions of pro-inflammatory cytokines, up-regulated expression of M2 subtype marker and secretion of anti-inflammatory cytokine. These results indicated Mg2+ could convert macrophages from M0 to M2 phenotype, and the bioeffects of MgMPs on human inflammatory cells were most likely due to the Mg2+-induced NF-κB activation reduction. Together, our results proved Mg2+ could be used as a new anti-inflammatory agent to suppress inflammation in clinical applications, which may provide new ideas for studying the immunomodulation of Mg-based implants on human immune system.
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Affiliation(s)
- Lei Sun
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, No. 37 XueYuan Road, Haidian District, Beijing 100083, China.,Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, No. 37 XueYuan Road, Haidian District, Beijing 100083, China
| | - Xiaoyu Li
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, No. 37 XueYuan Road, Haidian District, Beijing 100083, China.,Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, No. 37 XueYuan Road, Haidian District, Beijing 100083, China
| | - Menghan Xu
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, No. 37 XueYuan Road, Haidian District, Beijing 100083, China.,Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, No. 37 XueYuan Road, Haidian District, Beijing 100083, China
| | - Fenghe Yang
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, No. 37 XueYuan Road, Haidian District, Beijing 100083, China.,Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, No. 37 XueYuan Road, Haidian District, Beijing 100083, China
| | - Wei Wang
- Department of Immunology, School of Basic Medical Sciences, NHC Key Laboratory of Medical Immunology, Peking University, No. 38 XueYuan Road, Haidian District, Beijing 100191, China
| | - Xufeng Niu
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, No. 37 XueYuan Road, Haidian District, Beijing 100083, China.,Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, No. 37 XueYuan Road, Haidian District, Beijing 100083, China
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17
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Lorenzoni G, Swain S, Lanera C, Florin M, Baldi I, Iliceto S, Gregori D. High- and low-inpatients' serum magnesium levels are associated with in-hospital mortality in elderly patients: a neglected marker? Aging Clin Exp Res 2020; 32:407-413. [PMID: 31148098 DOI: 10.1007/s40520-019-01230-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 05/18/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Altered serum magnesium (Mg) level in the human body has been hypothesized to have a role in the prediction of hospitalization and mortality; however, the reported outcomes are not conclusive. AIMS The present study aimed to analyze the relationship between serum Mg and in-hospital mortality (IHM) in patients admitted to the medical ward of two hospitals in the Veneto region (Italy). METHODS Patients > 18 years hospitalized in the medical wards of the hospitals of Vittorio Veneto and Conegliano, Italy (from January 12, 2011, through December 27, 2016) with at least one measurement of serum Mg were included in the study. A logistic regression model was used to assess the unadjusted and adjusted (by age, gender, Charlson Comorbidity index, discharge diagnosis' class) association of serum Mg and IHM. RESULTS In total 5024 patients were analyzed, corresponding to 6980 total admissions. The unadjusted analysis showed that IHM risk was significantly higher with 0.2 mg/dl incremental serum Mg level change from 2.4 mg/dl to 2.6, (OR 1.71 95% CI 1.55-1.89) and with 0.2 mg/dl change from serum Mg level of 1.4 mg/dl to 1.2 mg/dl, (OR 1.28 95% CI 1.17-1.40). Such results were confirmed at adjusted analysis. DISCUSSION Present findings have relevant implications for the clinical management of patients suffering from medical conditions, highlighting the need for analyzing Mg concentration carefully. CONCLUSIONS Serum Mg levels seem to be a good predictor of IHM.
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Affiliation(s)
- Giulia Lorenzoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Loredan, 18, 35131, Padua, Italy
| | - Subhashisa Swain
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Loredan, 18, 35131, Padua, Italy
| | - Corrado Lanera
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Loredan, 18, 35131, Padua, Italy
| | - Mihaela Florin
- Medical Department, Vittorio Veneto Hospital, Vittorio Veneto, Italy
| | - Ileana Baldi
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Loredan, 18, 35131, Padua, Italy
| | - Sabino Iliceto
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Loredan, 18, 35131, Padua, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Loredan, 18, 35131, Padua, Italy.
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18
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Vesterlund GK, Thomsen T, Møller MH, Perner A. Effects of magnesium, phosphate and zinc supplementation in ICU patients-Protocol for a systematic review. Acta Anaesthesiol Scand 2020; 64:131-136. [PMID: 31506930 DOI: 10.1111/aas.13468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 09/03/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Depletion of the trace elements magnesium, phosphate and zinc is common in patients admitted to the intensive care unit (ICU). Observational studies have suggested worse outcome in patients with hypomagnesaemia, hypophosphataemia or hypozincaemia, but also inverse associations with worse outcome with too high serum levels. However, it is unclear whether data from randomised clinical trials (RCTs) confirm this. Accordingly, we plan to assess the balance between benefits and harms of supplementation as compared with placebo or no supplementation in adult ICU patients. METHODS We will conduct a systematic review of RCTs with meta-analysis and trial sequential analysis in accordance with the Cochrane Handbook for Systematic Reviews of Interventions, the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement and the Grading of Recommendation, Assessment, Development and Evaluation (GRADE) approach. We will assess the effects of any supplementation with magnesium, phosphate or zinc vs. placebo or no treatment in adult ICU patients. We will systematically search the Cochrane CENTRAL, Embase, PubMed, and for unpublished trials: ClinicalTrials.gov, the EU clinical Trials Register and the WHO International Clinical Trials Registry Platform. The primary outcomes will be days alive without mechanical ventilation and overall mortality. Secondary outcomes include use for mechanical ventilation, tachy-arrhythmias, use of vasopressors, length of hospital stay and use of renal replacement therapy. DISCUSSION The benefits and harms of supplementation therapy with magnesium, phosphate and zinc in general ICU patients are unknown. This outlined systematic review will provide data on the evidence, on which future recommendations for supplementation may be founded.
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Affiliation(s)
- Gitte Kingo Vesterlund
- Department of Intensive Care Copenhagen University Hospital, Rigshospitalet Copenhagen Denmark
| | - Thordis Thomsen
- Herlev Acute Critical and Emergency Care Science Unit (Herlev‐ACES) Herlev and Gentofte University Hospital Copenhagen Denmark
| | - Morten Hylander Møller
- Department of Intensive Care Copenhagen University Hospital, Rigshospitalet Copenhagen Denmark
- Centre for Research in Intensive Care (CRIC) Copenhagen Denmark
| | - Anders Perner
- Department of Intensive Care Copenhagen University Hospital, Rigshospitalet Copenhagen Denmark
- Centre for Research in Intensive Care (CRIC) Copenhagen Denmark
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19
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Suzuki M, Hatakeyama T, Nakamura R, Saiki T, Kamisasanuki T, Sugiki D, Matsushima H. Serum Magnesium Levels and Neurological Outcomes in Patients Undergoing Targeted Temperature Management After Cardiac Arrest. J Emerg Nurs 2020; 46:59-65. [DOI: 10.1016/j.jen.2019.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 09/18/2019] [Accepted: 10/04/2019] [Indexed: 10/25/2022]
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20
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Tazmini K, Nymo SH, Louch WE, Ranhoff AH, Øie E. Electrolyte imbalances in an unselected population in an emergency department: A retrospective cohort study. PLoS One 2019; 14:e0215673. [PMID: 31022222 PMCID: PMC6483356 DOI: 10.1371/journal.pone.0215673] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 04/05/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Although electrolyte imbalances (EIs) are common in the emergency department (ED), few studies have examined the occurrence of such conditions in an unselected population. OBJECTIVES To investigate the frequency of EI among adult patients who present to the ED, with regards to type and severity, and the association with age and sex of the patient, hospital length of stay (LOS), readmission, and mortality. METHODS A retrospective cohort study. All patients ≥18 years referred for any reason to the ED between January 1, 2010, and December 31, 2015, who had measured blood electrolytes were included. In total, 62 991 visits involving 31 966 patients were registered. RESULTS EIs were mostly mild, and the most common EI was hyponatremia (glucose-corrected) (24.6%). Patients with increasing severity of EI had longer LOS compared with patients with normal electrolyte measurements. Among all admitted patients, there were 12928 (20.5%) readmissions within 30 days from discharge during the study period. Hyponatremia (glucose-corrected) was associated with readmission, with an adjusted odds ratio (OR) of 1.25 (95% CI, 1.18-1.32). Hypomagnesemia and hypocalcemia (albumin-corrected) were also associated with readmission, with ORs of 1.25 (95% CI, 1.07-1.45) and 1.22 (95% CI, 1.02-1.46), respectively. Dysnatremia, dyskalemia, hypercalcemia, hypermagnesemia, and hyperphosphatemia were associated with increased in-hospital mortality, whereas all EIs except hypophosphatemia were associated with increased 30-day and 1-year mortality. CONCLUSIONS EIs were common and increasing severity of EIs was associated with longer LOS and increased in-hospital, 30-days and 1-year mortality. EI monitoring is crucial for newly admitted patients, and up-to-date training in EI diagnosis and treatment is essential for ED physicians.
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Affiliation(s)
- Kiarash Tazmini
- Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway
- * E-mail:
| | - Ståle H. Nymo
- Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway
| | - William E. Louch
- Institute of Experimental Medical Research, Oslo University Hospital, Ullevål and University of Oslo, Oslo, Norway
- Center for Heart Failure Research, University of Oslo, Oslo, Norway
| | - Anette H. Ranhoff
- Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Erik Øie
- Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway
- Center for Heart Failure Research, University of Oslo, Oslo, Norway
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21
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Meurer M, Höcherl K. Deregulated renal magnesium transport during lipopolysaccharide-induced acute kidney injury in mice. Pflugers Arch 2019; 471:619-631. [PMID: 30726531 DOI: 10.1007/s00424-019-02261-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 01/13/2019] [Accepted: 01/24/2019] [Indexed: 02/06/2023]
Abstract
Magnesium (Mg2+) abnormalities during sepsis have been reported, but the underlying mechanisms during acute inflammation are poorly understood. We hypothesized that a decrease in GFR and/or changes in transporters or channels for Mg2+ could be responsible for the observed Mg2+ abnormalities. Therefore, we studied the metabolism of Mg2+ in a murine model of endotoxemia. LPS-induced hypermagnesemia was paralleled by a decrease in creatinine clearance and an increase in the fractional excretion of Mg2+. In agreement with an altered renal Mg2+ handling, endotoxemia decreased the renal expression of claudin (Cldn) 10b, Cldn16, Cldn19, parvalbumin, and of the solute carrier family (Slc) 41a3. Further, LPS increased the renal expression of Cldn14 and Slc41a1. The renal expression of the transient receptor potential melastin (Trpm) 6, Trpm7, and of cyclin M (Cnnm) 2 was unaltered in response to LPS. In vitro studies support a direct effect on the expression of Cldn10b, Cldn14, Cldn16, and Cldn19. Further, endotoxemia increased the fractional excretion of sodium, which was paralleled by a decrease of important renal sodium transporters. In the large intestine, the expression of Trpm7 was increased in response to LPS, whereas the expression of Trpm6 was decreased. Cnnm4 mRNA levels were unchanged in the large intestine. Further, Cldn12 and Na+-H+ exchanger 3 (Slc9a3) expressions were decreased in the small intestine in response to LPS. Our findings indicate that endotoxemia is associated with hypermagnesemia and a disturbed Mg2+ handling. It seems likely that LPS-induced hypermagnesemia is due to the decrease in renal function in response to LPS.
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Affiliation(s)
- Manuel Meurer
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Fahrstr. 17, 91054, Erlangen, Germany
| | - Klaus Höcherl
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Fahrstr. 17, 91054, Erlangen, Germany.
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Broman M, Hansson F, Klarin B. Analysis of hypo- and hypermagnesemia in an intensive care unit cohort. Acta Anaesthesiol Scand 2018; 62:648-657. [PMID: 29341068 DOI: 10.1111/aas.13061] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 11/21/2017] [Accepted: 11/26/2017] [Indexed: 01/06/2023]
Abstract
INTRODUCTION The aim of this study was to evaluate if magnesium deviations correlate with higher 180 day overall mortality or increased morbidity, compared to controls. METHODS We conducted a retrospective study on 5369 patients with 22,003 magnesium values treated at the Adult Intensive Care Unit at Skåne University Hospital, Lund, Sweden during 2006-2014. The patients were retrospectively divided into a control group with only normal magnesium values 0.7-1.0 mmol/l, and three study groups; hypomagnesemic; Mg2+ < 0.7 mmol/l, hypermagnesemic; Mg2+ > 1.0 mmol/l and an unstable mixed group showing both hypo/hypermagnesemia. Gender, age, disease severity represented by maximum organ system SOFA score, renal SOFA score, lowest potassium value and diagnoses classes were included in a Cox hazard model in order to adjust for confounding factors, with time to death in the first 180 days from the ICU admission as outcome. RESULTS The hypermagnesemic study group and the mixed group showed increased hazard ratios for mortality; 1.4 (CI 98.3% 1.2, 1.6, P < 0.0001) and 2.1 (CI 98.3% 1.2, 2.8, P < 0.0001) respectively, compared to controls, while the hypomagnesemic group did not reach significance. In addition, patients in the hypermagnesemic and the mixed groups are older, more ill with significantly higher EMR and SOFA scores and show significantly longer ventilator times and ICU stays, compared to controls. CONCLUSIONS Patients with magnesium deviations are more ill compared to patients with explicitly normal magnesium values throughout the ICU stay. Cox analysis suggests that the magnesium deviation itself might have an impact on mortality.
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Affiliation(s)
- M. Broman
- Skåne University Hospital; Lund Sweden
| | | | - B. Klarin
- Skåne University Hospital; Lund Sweden
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Muñoz-Castañeda JR, Pendón-Ruiz de Mier MV, Rodríguez M, Rodríguez-Ortiz ME. Magnesium Replacement to Protect Cardiovascular and Kidney Damage? Lack of Prospective Clinical Trials. Int J Mol Sci 2018; 19:E664. [PMID: 29495444 PMCID: PMC5877525 DOI: 10.3390/ijms19030664] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 02/12/2018] [Accepted: 02/21/2018] [Indexed: 12/13/2022] Open
Abstract
Patients with advanced chronic kidney disease exhibit an increase in cardiovascular mortality. Recent works have shown that low levels of magnesium are associated with increased cardiovascular and all-cause mortality in hemodialysis patients. Epidemiological studies suggest an influence of low levels of magnesium on the occurrence of cardiovascular disease, which is also observed in the normal population. Magnesium is involved in critical cellular events such as apoptosis and oxidative stress. It also participates in a number of enzymatic reactions. In animal models of uremia, dietary supplementation of magnesium reduces vascular calcifications and mortality; in vitro, an increase of magnesium concentration decreases osteogenic transdifferentiation of vascular smooth muscle cells. Therefore, it may be appropriate to evaluate whether magnesium replacement should be administered in an attempt to reduce vascular damage and mortality in the uremic population In the present manuscript, we will review the magnesium homeostasis, the involvement of magnesium in enzymatic reactions, apoptosis and oxidative stress and the clinical association between magnesium and cardiovascular disease in the general population and in the context of chronic kidney disease. We will also analyze the role of magnesium on kidney function. Finally, the experimental evidence of the beneficial effects of magnesium replacement in chronic kidney disease will be thoroughly described.
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Affiliation(s)
- Juan R Muñoz-Castañeda
- Nephrology Service, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), University Hospital Reina Sofía, University of Córdoba, 14004 Córdoba, Spain.
- Red de Investigación Renal (REDinREN), Instituto de Salud Carlos III, 28029 Madrid, Spain.
| | - María V Pendón-Ruiz de Mier
- Nephrology Service, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), University Hospital Reina Sofía, University of Córdoba, 14004 Córdoba, Spain.
- Red de Investigación Renal (REDinREN), Instituto de Salud Carlos III, 28029 Madrid, Spain.
| | - Mariano Rodríguez
- Nephrology Service, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), University Hospital Reina Sofía, University of Córdoba, 14004 Córdoba, Spain.
- Red de Investigación Renal (REDinREN), Instituto de Salud Carlos III, 28029 Madrid, Spain.
| | - María E Rodríguez-Ortiz
- Nephrology Service, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), University Hospital Reina Sofía, University of Córdoba, 14004 Córdoba, Spain.
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Nishikawa M, Shimada N, Kanzaki M, Ikegami T, Fukuoka T, Fukushima M, Asano K. The characteristics of patients with hypermagnesemia who underwent emergency hemodialysis. Acute Med Surg 2018; 5:222-229. [PMID: 29988705 PMCID: PMC6028801 DOI: 10.1002/ams2.334] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 01/01/2018] [Indexed: 12/17/2022] Open
Abstract
Aim This study aimed to clarify the characteristics of patients who presented with severe hypermagnesemia and subsequently underwent emergency hemodialysis. Methods We investigated the age, gender, complications, clinical symptoms, causal drugs, electrocardiogram findings, and laboratory data of 15 patients. Results Magnesium oxide had been administered in all cases and 14 patients were over 65 years old. The male : female ratio was 6:9. Chief complaints included a disturbance of consciousness, hypotension, bradycardia, and respiratory failure. The median serum magnesium value before hemodialysis was 6.0 (3.7–18.6) mg/dL. The daily dosage of magnesium oxide was ≤ 2.0 g in 12 cases. The median serum creatinine value before hemodialysis was 5.39 (0.54–10.29) mg/dL. However, in two cases, the creatinine value was not elevated. Complications of acute kidney injury exacerbated the hypermagnesemia in nine cases. Conclusions We recommend that the serum magnesium value should be measured in older patients who are taking magnesium oxide and are showing signs and symptoms of a disturbance of consciousness, hypotension, bradycardia, and respiratory failure of an uncertain etiology, even if the serum creatinine value is not elevated or the dosage of magnesium oxide is within recommended levels.
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Affiliation(s)
- Mana Nishikawa
- Department of Nephrology Kurashiki Central Hospital Kurashiki Japan
| | - Noriaki Shimada
- Department of Nephrology Kurashiki Central Hospital Kurashiki Japan
| | - Motoko Kanzaki
- Department of Nephrology Kurashiki Central Hospital Kurashiki Japan
| | - Tetsunori Ikegami
- Department of Emergency Medicine Kurashiki Central Hospital Kurashiki Japan
| | - Toshio Fukuoka
- Department of General Medicine Kurashiki Central Hospital Kurashiki Japan
| | - Masaki Fukushima
- Department of Internal Medicine Shigei Research Institute Hospital Okayama Japan
| | - Kenichiro Asano
- Department of Nephrology Kurashiki Central Hospital Kurashiki Japan
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Gilbert RE, Mende C, Vijapurkar U, Sha S, Davies MJ, Desai M. Effects of Canagliflozin on Serum Magnesium in Patients With Type 2 Diabetes Mellitus: A Post Hoc Analysis of Randomized Controlled Trials. Diabetes Ther 2017; 8:451-458. [PMID: 28197834 PMCID: PMC5380494 DOI: 10.1007/s13300-017-0232-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION The objective of this study was to evaluate the effects of canagliflozin, a sodium glucose co-transporter 2 inhibitor, on serum magnesium in hypomagnesemic patients with type 2 diabetes. METHODS This post hoc analysis was based on pooled data from four placebo-controlled studies of canagliflozin (N = 2313). The proportion of patients with baseline serum magnesium <0.74 mmol/L who achieved serum magnesium ≥0.74 mmol/L at week 26 was evaluated. RESULTS At week 26, canagliflozin 100 and 300 mg increased serum magnesium versus placebo in patients with baseline serum magnesium <0.74 mmol/L (17.0% and 19.0% vs 3.9%) and ≥0.74 mmol/L (4.9% and 7.0% vs -1.4%). More patients with baseline serum magnesium <0.74 mmol/L had serum magnesium ≥0.74 mmol/L at week 26 with canagliflozin 100 and 300 mg versus placebo (74.1% and 80.6% vs 28.8%). CONCLUSIONS Canagliflozin was associated with normalization of serum magnesium in hypomagnesemic patients with type 2 diabetes, potentially leading to improved cardiometabolic outcomes. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifiers, NCT01081834, NCT01106677, NCT01106625, NCT01106690.
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Affiliation(s)
| | | | | | - Sue Sha
- Janssen Research & Development, LLC, Raritan, NJ, USA
| | | | - Mehul Desai
- Janssen Research & Development, LLC, Raritan, NJ, USA
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26
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In vitro and in vivo responses of macrophages to magnesium-doped titanium. Sci Rep 2017; 7:42707. [PMID: 28198427 PMCID: PMC5309879 DOI: 10.1038/srep42707] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 01/12/2017] [Indexed: 12/26/2022] Open
Abstract
Modulating immune response to biomaterials through changing macrophage polarization has been proven to be a promising strategy to elicit beneficial outcomes in tissue repair. The objective of this study was to evaluate the response of macrophage polarization to titanium doped with magnesium (0.1~0.35%), which was prepared through the magnesium plasma immersion ion implantation (Mg PIII) technique. The M1/M2 polarization profile of macrophages was investigated using a murine cell line RAW 264.7 in vitro and a murine air pouch model in vivo. Our results demonstrated that the Mg PIII-treated titanium induced a higher percentage of M2 macrophages and higher concentrations of the anti-inflammatory cytokines interleukin (IL)-4 and IL-10. Genes encoding two growth factors, bone morphogenetic protein 2 (BMP2) and vascular endothelial growth factor (VEGF) were up-regulated, thus indicating the ability of the M2 phenotype to promote wound healing. The nuclear factor κB (NF-κB) signalling pathway was down-regulated. In vivo the Mg PIII -treated titanium elicited a similar effect on macrophage polarization and induced thinner fibrous capsule formation and a decrease in infiltrated cells. These results indicate that Mg PIII treatment has the immunomodulatory potential to elicit the pro-healing M2-polarized macrophage phenotype, thus providing new insight into the development of immunomodulatory biomaterials.
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Naksuk N, Hu T, Krittanawong C, Thongprayoon C, Sharma S, Park JY, Rosenbaum AN, Gaba P, Killu AM, Sugrue AM, Peeraphatdit T, Herasevich V, Bell MR, Brady PA, Kapa S, Asirvatham SJ. Association of Serum Magnesium on Mortality in Patients Admitted to the Intensive Cardiac Care Unit. Am J Med 2017; 130:229.e5-229.e13. [PMID: 27639872 DOI: 10.1016/j.amjmed.2016.08.033] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 08/16/2016] [Accepted: 08/16/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Although electrolyte disturbances may affect cardiac action potential, little is known about the association between serum magnesium and corrected QT (QTc) interval as well as clinical outcomes. METHODS A consecutive 8498 patients admitted to the Mayo Clinic Hospital-Rochester cardiac care unit (CCU) from January 1, 2004 through December 31, 2013 with 2 or more documented serum magnesium levels, were studied to test the hypothesis that serum magnesium levels are associated with in-hospital mortality, sudden cardiac death, and QTc interval. RESULTS Patients were 67 ± 15 years; 62.2% were male. The primary diagnoses for CCU admissions were acute myocardial infarction (50.7%) and acute decompensated heart failure (42.5%), respectively. Patients with higher magnesium levels were older, more likely male, and had lower glomerular filtration rates. After multivariate analyses adjusted for clinical characteristics including kidney disease and serum potassium, admission serum magnesium levels were not associated with QTc interval or sudden cardiac death. However, the admission magnesium levels ≥2.4 mg/dL were independently associated with an increase in mortality when compared with the reference level (2.0 to <2.2 mg/dL), having an adjusted odds ratio of 1.80 and a 95% confidence interval of 1.25-2.59. The sensitivity analysis examining the association between postadmission magnesium and analysis that excluded patients with kidney failure and those with abnormal serum potassium yielded similar results. CONCLUSION This retrospective study unexpectedly observed no association between serum magnesium levels and QTc interval or sudden cardiac death. However, serum magnesium ≥2.4 mg/dL was an independent predictor of increased hospital morality among CCU patients.
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Affiliation(s)
- Niyada Naksuk
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minn
| | - Tiffany Hu
- Mayo Medical School, Mayo Clinic College of Medicine, Rochester, Minn
| | - Chayakrit Krittanawong
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minn; Department of Medicine, Cleveland Clinic, Ohio; CharlesMedLab, Cleveland, Ohio
| | - Charat Thongprayoon
- Department of Anesthesiology, Mayo Clinic, Rochester, Minn; Department of Internal Medicine, Mary Imogene Bassett Healthcare, Cooperstown, NY
| | - Sunita Sharma
- Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minn; Division of Cardiovascular Diseases, Lahey Hospital and Medical Center, Burlington, Mass
| | - Jae Yoon Park
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minn
| | - Andrew N Rosenbaum
- Division of Cardiovascular Diseases, Lahey Hospital and Medical Center, Burlington, Mass
| | - Prakriti Gaba
- Mayo Medical School, Mayo Clinic College of Medicine, Rochester, Minn
| | - Ammar M Killu
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minn
| | - Alan M Sugrue
- Division of Cardiovascular Diseases, Lahey Hospital and Medical Center, Burlington, Mass
| | - Thoetchai Peeraphatdit
- Division of Internal Medicine, Department of Medicine Education, University of Minnesota Twin Cities, Minneapolis; Division of Gastroenterology, Department of Medicine, Mayo Clinic, Rochester, Minn
| | | | - Malcolm R Bell
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minn
| | - Peter A Brady
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minn
| | - Suraj Kapa
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minn
| | - Samuel J Asirvatham
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minn; Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minn.
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Tang H, Zhang X, Zhang J, Li Y, Del Gobbo LC, Zhai S, Song Y. Elevated serum magnesium associated with SGLT2 inhibitor use in type 2 diabetes patients: a meta-analysis of randomised controlled trials. Diabetologia 2016; 59:2546-2551. [PMID: 27628105 DOI: 10.1007/s00125-016-4101-6] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 08/18/2016] [Indexed: 12/22/2022]
Abstract
AIMS/HYPOTHESIS By analysing available evidence from randomised controlled trials (RCTs), we aimed to examine whether and to what extent sodium-glucose cotransporter 2 (SGLT2) inhibitors affect serum electrolyte levels in type 2 diabetes patients. METHODS We searched PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) and ClinicalTrials.gov up to 24 May 2016 for published RCTs of SGLT2 inhibitors that reported changes in serum electrolyte levels. Weighted mean differences (WMD) between each SGLT2 inhibitor and placebo were calculated using a random-effects model. Dose-dependent relationships for each SGLT2 inhibitor were evaluated using meta-regression analysis. RESULTS Eighteen eligible RCTs, including 15,309 patients and four SGLT2 inhibitors (canagliflozin, dapagliflozin, empagliflozin and ipragliflozin) were evaluated. In patients without chronic kidney disease, each SGLT2 inhibitor significantly increased serum magnesium levels compared with placebo (canagliflozin: WMD 0.06 mmol/l for 100 mg and 0.09 mmol/l for 300 mg; dapagliflozin: WMD 0.1 mmol/l for 10 mg; empagliflozin: WMD 0.04 mmol/l for 10 mg and 0.07 mmol/l for 25 mg; and ipragliflozin: WMD 0.05 mmol/l for 50 mg). Canagliflozin increased serum magnesium in a linear dose-dependent manner (p = 0.10). Serum phosphate was significantly increased by dapagliflozin. Serum sodium appeared to significantly differ by SGLT2 inhibitor type. No significant changes in serum calcium and potassium were observed. Findings were robust after including trials involving patients with chronic kidney disease. CONCLUSIONS/INTERPRETATION SGLT2 inhibitors marginally increased serum magnesium levels in type 2 diabetes patients indicating a drug class effect. Further investigations are required to examine the clinical significance of elevated magnesium levels in individuals with type 2 diabetes.
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Affiliation(s)
- Huilin Tang
- Department of Pharmacy, Peking University Third Hospital, Beijing, People's Republic of China
- Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, 1050 Wishard Blvd, Indianapolis, IN, 46202, USA
- Center for Pharmacoepidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA
| | - Xi Zhang
- Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, 1050 Wishard Blvd, Indianapolis, IN, 46202, USA
- Center for Pharmacoepidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA
| | - Jingjing Zhang
- Division of Nephrology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Yufeng Li
- Department of Endocrinology, Beijing Pinggu Hospital, Beijing, People's Republic of China
| | - Liana C Del Gobbo
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, CA, USA
| | - Suodi Zhai
- Department of Pharmacy, Peking University Third Hospital, Beijing, People's Republic of China
| | - Yiqing Song
- Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, 1050 Wishard Blvd, Indianapolis, IN, 46202, USA.
- Center for Pharmacoepidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA.
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Helliksson F, Wernerman J, Wiklund L, Rosell J, Karlsson M. The combined use of three widely available biochemical markers as predictor of organ failure in critically ill patients. Scandinavian Journal of Clinical and Laboratory Investigation 2016; 76:479-85. [PMID: 27362714 DOI: 10.1080/00365513.2016.1201850] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND We hypothesized that lactate dehydrogenase, LDH/albumin ratio in combination with or without magnesium (Mg(2+)) could predict organ failure in critically ill adult patients. The aim of this study was to describe a new risk index for organ failure or mortality in critically ill patients based on a combination of these routinely available biochemical plasma biomarkers. METHODS Patients ≥ 18 years admitted to the intensive care unit (ICU) were screened. Albumin and LDH were analyzed at the time of admission to ICU (n = 347). Organ failure assessed with 'Sequential Organ Failure Assessment' (SOFA) score was used, and 30-day mortality was recorded. The predictive value of the test was calculated using the areas under the receiving operating characteristic (ROC) curve. RESULTS The LDH/albumin ratio was higher in patients who developed organ failure as compared to those who did not (p < 0.001). The areas under the ROC curve were 0.77 both for prediction of multiple organ failure and for 30-day mortality. In a subgroup of patients (n = 183) admitted to ICU from the emergency department, the predictive values were 0.86 and 0.80, respectively. CONCLUSION The LDH/albumin ratio at ICU admission was associated with the development of multiple organ failure and 30-day mortality in this prospective study. The clinical value of this biomarker as a predictor of organ failure in critically ill patients is yet to be defined.
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Affiliation(s)
- Fredrik Helliksson
- a Department of Clinical Science , Intervention, and Technology, CLINTEC, Karolinska Institutet , Stockholm , Sweden ;,b Department of Anesthesiology and Intensive Care , Central Hospital , Karlstad , Sweden
| | - Jan Wernerman
- a Department of Clinical Science , Intervention, and Technology, CLINTEC, Karolinska Institutet , Stockholm , Sweden
| | - Lars Wiklund
- c Department of Surgical Sciences , Uppsala University , Uppsala , Sweden
| | - Jon Rosell
- b Department of Anesthesiology and Intensive Care , Central Hospital , Karlstad , Sweden
| | - Mathias Karlsson
- d Department of Clinical Science and Education , Karolinska Institutet Södersjukhuset , Stockholm , Sweden ;,e Department of Clinical Chemistry , Central Hospital , Karlstad , Sweden
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