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Savaş EM, Yegin ZA, Kök Mİ, Karayel HT, Özkurt ZN, Bozer MN, Çamoğlu M, Gülbahar Ö. Hypomagnesemia May Predict Better Survival and Reduced Nonrelapse Mortality in Allogeneic Hematopoietic Stem Cell Transplantation Recipients. Transplant Proc 2024; 56:386-393. [PMID: 38365511 DOI: 10.1016/j.transproceed.2024.01.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/16/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Magnesium (Mg) is an essential element that is required as a cofactor for many cellular reactions, including immunologic pathways. The aim of this study was to investigate the potential impact of serum Mg levels on allogeneic hematopoietic stem cell transplantation (alloHSCT) outcomes. METHODS Medical records of 340 alloHSCT recipients (median age: 45 [18-71] years; M/F: 210/130) were reviewed for this retrospective study. Serum Mg levels on days -28, -7, 0, +7, +14, +21, +30, +60, and +90 were included in the analysis. RESULTS Serum Mg+14 levels predicted nonrelapse mortality (NRM) (P = .025) and had a significant impact on the development of mucositis (P = .027), fungal infection (P = .006), engraftment syndrome (P < .001), sinusoidal obstruction syndrome (SOS) (P = .001), cytomegalovirus (CMV) reactivation (P = .039), and acute graft vs host disease (GvHD) (P < .001). Based on the optimal threshold of serum Mg+14 level (1.33 mg/dL; area under the curve: 0.581 [0.515-0.648]; P = .018), the study group was divided into 2 subgroups as low- and high-Mg+14. The incidence of acute GvHD (P = .002), SOS (P = .013), engraftment syndrome (P = .013), CMV reactivation (P = .001), and Epstein Barr virus reactivation (P = .005) was significantly lower in low-Mg+14 group. The probability of overall survival (OS) was significantly better (P = .002), whereas NRM was lower in the low-Mg+14 group (P = .001). CONCLUSION Hypomagnesemia seems to provide a considerable advantage for the post-transplant outcome, which may confirm its potential role in the immunologic microenvironment and adaptive immunity.
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Affiliation(s)
- Emine Merve Savaş
- Gazi University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Zeynep Arzu Yegin
- Gazi University Faculty of Medicine, Department of Hematology, Ankara, Turkey.
| | - Münevver İrem Kök
- Gazi University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Hande Tuğba Karayel
- Gazi University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Zübeyde Nur Özkurt
- Gazi University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Merve Nazlı Bozer
- Gazi University Faculty of Medicine, Department of Internal Medicine, Ankara, Turkey
| | - Melike Çamoğlu
- Gazi University Faculty of Medicine, Department of Internal Medicine, Ankara, Turkey
| | - Özlem Gülbahar
- Gazi University Faculty of Medicine, Department of Medical Biochemistry, Ankara, Turkey
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Yang W, Lian X, Chen H. The association of serum magnesium with infection in new-onset systemic lupus erythematosus patients. Lupus 2023; 32:380-387. [PMID: 36595713 DOI: 10.1177/09612033221149884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To assess the association of serum magnesium with infection in new-onset systemic lupus erythematosus (SLE) patients. METHODS We conducted a single-center retrospective cohort study of new-onset SLE patients from 2012 to 2021. The hospitalized SLE patients were divided into infection and noninfection groups. Logistic regression analysis was conducted to examine the association of hypomagnesemia with infection. RESULTS A total of 476 new-onset SLE patients were included, with 299 cases in the infection group and 177 cases in the noninfection group. The patients were mostly females (81.7%). The average age at diagnosis was 43.7 years. The median duration was 1.0 month. The prevalence of hypomagnesemia (<0.70), normomagnesemia (0.70-1.10), and hypermagnesemia (>1.10) in new-onset SLE patients was 14.3%, 83.4%, and 2.3%, respectively. The prevalence of hypomagnesemia was 18.4% in the infection group and 7.3% in the noninfection group (p = .001). The baseline value of serum magnesium was 0.819 mmol/L, with values of 0.799 mmol/L in the infection group and 0.854 mmol/L in the noninfection group (p = .000). The following clinical variables were significantly different between the two groups (p < .05): age, duration, hospitalization stay, fever, serositis, and SLE Disease Activity Index 2000 (SLEDAI 2K). The laboratory parameters, including hemoglobin, white blood cell count, albumin level, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), procalcitonin, and complement C3 were also significantly different between the two groups (p < .05). The mortality was 4.4% (21/476), with 20 cases occurring in the infection group. Logistic regression analysis showed that hypomagnesemia was associated with an increased risk of infection (p = .001) and poor prognosis (p = .015). CONCLUSION Hypermagnesemia was rare in new-onset SLE patients. Hypomagnesemia was common and was associated with an increased risk of infection in new-onset SLE patients.
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Affiliation(s)
- Wenfang Yang
- Department of Nephrology, 117893Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
| | - Xuejian Lian
- Department of Nephrology, 117893Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
| | - Hongpu Chen
- Department of Rheumatology, 117893Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
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Hanaoka H, Kikuchi J, Kaneko Y, Seki N, Tsujimoto H, Chiba K, Takeuchi T. Proton Pump Inhibitor and Tacrolimus Uses are Associated With Hypomagnesemia in Connective Tissue Disease: a Potential Link With Renal Dysfunction and Recurrent Infection. Front Pharmacol 2021; 12:616719. [PMID: 34093176 PMCID: PMC8173076 DOI: 10.3389/fphar.2021.616719] [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: 10/22/2020] [Accepted: 05/10/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Low levels of serum magnesium perturb renal tubular cell function and lymphocytes, resulting in renal deterioration and an imbalance in mononuclear cells. This study investigated the mechanism and influence of hypomagnesemia in patients with connective tissue disease. Methods: We retrospectively evaluated patients with connective tissue disease and available serum magnesium data who visited Keio University Hospital in 2019. Patients were divided into two groups: those with (serum magnesium < 1.8 mg/dl) and those without hypomagnesemia; their rates of hospitalization for severe infection and cumulative renal deterioration were compared. Patients’ fractions of lymphocytes and natural killer and dendritic cell subsets, as measured by fluorescence-activated cell sorting (FACS) analysis, were also compared. Results: Among 284 patients, hypomagnesemia was detected in 63 (22.2%). Multivariate analysis revealed that the use of proton pump inhibitors [odds ratio (OR), 1.48; p = 0.01] and tacrolimus (OR, 6.14; p < 0.01) was independently associated with hypomagnesemia. In addition, the renal deterioration rate was significantly higher in tacrolimus and/or proton pump inhibitor users with hypomagnesemia (p = 0.01). The hospitalization rate for severe infection was also higher in patients with hypomagnesemia (p = 0.04). FACS analysis showed lower CD8+ T cell, CD19+ B cell, natural killer cell, and dendritic cell counts in patients with hypomagnesemia (p = 0.03, p = 0.02, p = 0.02, and p = 0.03, respectively). Conclusion: The use of tacrolimus and proton pump inhibitors may be associated with hypomagnesemia and lead to poor renal outcomes and severe infection in patients with connective tissue disease.
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Affiliation(s)
- Hironari Hanaoka
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan
| | - Jun Kikuchi
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan
| | - Yuko Kaneko
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan
| | - Noriyasu Seki
- Mitsubishi Tanabe Pharma Corporation, Yokohama, Japan
| | | | - Kenji Chiba
- Mitsubishi Tanabe Pharma Corporation, Yokohama, Japan
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan
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Zhang F, Wu X, Wen Y, Zhan X, Peng FF, Wang X, Qian Z, Feng X. Hypomagnesemia Is a Risk Factor for Cardiovascular Disease- and Noncardiovascular Disease-Related Mortality in Peritoneal Dialysis Patients. Blood Purif 2021; 51:23-30. [PMID: 33882494 DOI: 10.1159/000514148] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/30/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE Recent research has shown that hypomagnesemia is associated with increased all-cause mortality in hemodialysis patients. However, the relationship between the long-term prognosis of peritoneal dialysis (PD) and the study is not yet clear. This study will analyze the effects of hypomagnesemia on all-cause, cardiovascular diseases (CVD), and non-CVD mortality in PD patients. METHOD In a retrospective cohort study, 1,004 samples were selected from 7 PD centers in China. Based on the baseline blood magnesium level at the beginning of stable dialysis, all patients were classified into blood magnesium <0.7 mmol/L group, 0.7-1.2 mmol/L group, and >1.2 mmol/L group (the end event was death). The Kaplan-Meier method was used to calculate the difference in cumulative survival rate; the Cox proportional hazard model was used to analyze the risk factors of all-cause, CVD, and non-CVD death causes. RESULTS Cox multiple regression analysis results (reference comparison of 0.7-1.2 mmol/L group): patients with serum magnesium <0.7 mmol/L have a higher risk ratio of all-cause mortality (HR = 1.580, 95% CI: 1.222-2.042, p = 0.001), and it is also obvious after correction by multiple models (HR = 1.578, 95% CI: 1.196-2.083, p = 0.001). Subgroup analysis of the causes of death was as follows: CVD risk (HR = 1.628, 95% CI: 1.114-2.379, p = 0.012) and non-CVD risk (HR = 1.521, 95% CI: 1.011-2.288, p = 0.044). Further analysis of the causes of infection-related death in non-CVD is also significant (HR = 1.919, 95% CI: 1.131-3.1257, p = 0.016). On the other hand, the serum magnesium>1.2 mmol/L group had lower all-cause mortality after correction (HR = 0.687, 95% CI: 0.480-0.985, p = 0.041), and subgroup analysis of the cause of death had no statistical significance (p > 0.05). CONCLUSIONS Hypomagnesemia (serum magnesium <0.7 mmol/L) during stable dialysis in PD patients is a risk factor for CVD- and non-CVD-related mortality, especially infection-related death causes.
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Affiliation(s)
- Fengping Zhang
- Department of Nephrology, Jiujiang No. 1 People's Hospital, Jiujiang, China
| | - Xianfeng Wu
- Department of Nephrology, Affiliated Sixth People's Hospital, Shanghai, China
| | - Yueqiang Wen
- Department of Nephrology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaojiang Zhan
- Department of Nephrology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Fen Fen Peng
- Department of Nephrology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Xiaoyang Wang
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhou Qian
- Department of Medical Statistics, Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaoran Feng
- Department of Nephrology, Jiujiang No. 1 People's Hospital, Jiujiang, China
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Odler B, Deak AT, Pregartner G, Riedl R, Bozic J, Trummer C, Prenner A, Söllinger L, Krall M, Höflechner L, Hebesberger C, Boxler MS, Berghold A, Schemmer P, Pilz S, Rosenkranz AR. Hypomagnesemia Is a Risk Factor for Infections after Kidney Transplantation: A Retrospective Cohort Analysis. Nutrients 2021; 13:1296. [PMID: 33919913 PMCID: PMC8070921 DOI: 10.3390/nu13041296] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/07/2021] [Accepted: 04/07/2021] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Magnesium (Mg2+) deficiency is a common finding in the early phase after kidney transplantation (KT) and has been linked to immune dysfunction and infections. Data on the association of hypomagnesemia and the rate of infections in kidney transplant recipients (KTRs) are sparse. METHODS We conducted a single-center retrospective cohort study of KTRs transplanted between 2005 and 2015. Laboratory data, including serum Mg2+ (median time of the Mg2+ measurement from KT: 29 days), rate of infections including mainly urinary tract infections (UTI), and common transplant-related viral infections (CMV, polyoma, EBV) in the early phase after KT were recorded. The primary outcome was the incidence of infections within one year after KT, while secondary outcomes were hospitalization due to infection, incidence rates of long-term (up to two years) infections, and all-cause mortality. RESULTS We enrolled 376 KTRs of whom 229 patients (60.9%) suffered from Mg2+ deficiency defined as a serum Mg2+ < 0.7 mmol/L. A significantly higher incidence rate of UTIs and viral infections was observed in patients with versus without Mg2+ deficiency during the first year after KT (58.5% vs. 47.6%, p = 0.039 and 69.9% vs. 51.7%, p < 0.001). After adjustment for potential confounders, serum Mg2+ deficiency remained an independent predictor of both UTIs and viral infections (odds ratio (OR): 1.73, 95% CI: 1.04-2.86, p = 0.035 and OR: 2.05, 95% CI: 1.23-3.41, p = 0.006). No group differences according to Mg2+ status in hospitalizations due to infections and infection incidence rates in the 12-24 months post-transplant were observed. In the Cox regression analysis, Mg2+ deficiency was not significantly associated with all-cause mortality (HR: 1.15, 95% CI: 0.70-1.89, p = 0.577). CONCLUSIONS KTRs suffering from Mg2+ deficiency are at increased risk of UTIs and viral infections in the first year after KT. Interventional studies investigating the effect of Mg2+ supplementation on Mg2+ deficiency and viral infections in KTRs are needed.
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Affiliation(s)
- Balazs Odler
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, A-8036 Graz, Austria; (B.O.); (A.T.D.); (J.B.); (A.P.); (L.S.); (M.K.); (L.H.); (C.H.); (M.S.B.)
- Transplant Center Graz, Medical University of Graz, A-8036 Graz, Austria;
| | - Andras T. Deak
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, A-8036 Graz, Austria; (B.O.); (A.T.D.); (J.B.); (A.P.); (L.S.); (M.K.); (L.H.); (C.H.); (M.S.B.)
- Transplant Center Graz, Medical University of Graz, A-8036 Graz, Austria;
| | - Gudrun Pregartner
- Institute of Medical Informatics, Statistics and Documentation, Medical University of Graz, A-8036 Graz, Austria; (G.P.); (R.R.); (A.B.)
| | - Regina Riedl
- Institute of Medical Informatics, Statistics and Documentation, Medical University of Graz, A-8036 Graz, Austria; (G.P.); (R.R.); (A.B.)
| | - Jasmin Bozic
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, A-8036 Graz, Austria; (B.O.); (A.T.D.); (J.B.); (A.P.); (L.S.); (M.K.); (L.H.); (C.H.); (M.S.B.)
| | - Christian Trummer
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, A-8036 Graz, Austria; (C.T.); (S.P.)
| | - Anna Prenner
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, A-8036 Graz, Austria; (B.O.); (A.T.D.); (J.B.); (A.P.); (L.S.); (M.K.); (L.H.); (C.H.); (M.S.B.)
- Transplant Center Graz, Medical University of Graz, A-8036 Graz, Austria;
| | - Lukas Söllinger
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, A-8036 Graz, Austria; (B.O.); (A.T.D.); (J.B.); (A.P.); (L.S.); (M.K.); (L.H.); (C.H.); (M.S.B.)
| | - Marcell Krall
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, A-8036 Graz, Austria; (B.O.); (A.T.D.); (J.B.); (A.P.); (L.S.); (M.K.); (L.H.); (C.H.); (M.S.B.)
| | - Lukas Höflechner
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, A-8036 Graz, Austria; (B.O.); (A.T.D.); (J.B.); (A.P.); (L.S.); (M.K.); (L.H.); (C.H.); (M.S.B.)
| | - Carina Hebesberger
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, A-8036 Graz, Austria; (B.O.); (A.T.D.); (J.B.); (A.P.); (L.S.); (M.K.); (L.H.); (C.H.); (M.S.B.)
- Transplant Center Graz, Medical University of Graz, A-8036 Graz, Austria;
| | - Matias S. Boxler
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, A-8036 Graz, Austria; (B.O.); (A.T.D.); (J.B.); (A.P.); (L.S.); (M.K.); (L.H.); (C.H.); (M.S.B.)
| | - Andrea Berghold
- Institute of Medical Informatics, Statistics and Documentation, Medical University of Graz, A-8036 Graz, Austria; (G.P.); (R.R.); (A.B.)
| | - Peter Schemmer
- Transplant Center Graz, Medical University of Graz, A-8036 Graz, Austria;
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, A-8036 Graz, Austria
| | - Stefan Pilz
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, A-8036 Graz, Austria; (C.T.); (S.P.)
| | - Alexander R. Rosenkranz
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, A-8036 Graz, Austria; (B.O.); (A.T.D.); (J.B.); (A.P.); (L.S.); (M.K.); (L.H.); (C.H.); (M.S.B.)
- Transplant Center Graz, Medical University of Graz, A-8036 Graz, Austria;
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Peng X, Xiang R, Li X, Tian H, Li C, Peng Z, Xiang M. Magnesium deficiency in liver cirrhosis: a retrospective study. Scand J Gastroenterol 2021; 56:463-468. [PMID: 33646920 DOI: 10.1080/00365521.2021.1888154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Magnesium, known as "the forgotten electrolyte", is an essential element of life. Magnesium deficiency is implicated in many diseases, including liver cirrhosis. This study aimed to explore the prevalence of magnesium deficiency in liver cirrhosis and investigate the relationship between magnesium levels and complication of liver cirrhosis and clinical outcomes. PATIENTS AND METHODS Cirrhotic patients with serum magnesium levels measured were retrospectively identified from 2016 to 2017. Demographics, laboratory parameters, complications were collected. The Child-Pugh class, MELD score, and ALBI score were calculated. RESULTS The mean serum magnesium level of all 152 patients was lower than the normal, including 92 patients diagnosed with magnesium deficiency. Compared to Child-Pugh class A, magnesium levels were significantly lower in the patients with Child-Pugh class B or C (F = 10.26, p < .05). Magnesium levels were also considerably lower in the group with MELD score ≥21, compared to the other two groups with MELD score < 15 or 15-20 (F = 6.59, p < .05). Similarly, magnesium levels were significantly lower in the group with ALBI score > -1.39 (grade 3), compared to the other two groups with ALBI with score ≤ -2.6 (grade 1) or > -2.6, ≤ -1.39 (grade 2) (F = 8.44, p<.001). Furthermore, magnesium levels were lower in cirrhotic patients with infection. Magnesium-deficient patients had lower transplant-free survival rates than non-deficient patients. CONCLUSION Magnesium deficiency is highly prevalent in cirrhotic patients. Magnesium deficiency is related to worse transplant-free survival, infection and the severity of liver cirrhosis.
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Affiliation(s)
- Xia Peng
- Department of Gastroenterology, The First Affiliated Hospital of Jishou University, Jishou, China
| | - Rengyun Xiang
- Department of Gastroenterology, The First Affiliated Hospital of Jishou University, Jishou, China
| | - Xuefeng Li
- Department of Gastroenterology, The First Affiliated Hospital of Jishou University, Jishou, China
| | - Hui Tian
- Department of Gastroenterology, The First Affiliated Hospital of Jishou University, Jishou, China
| | - Cuiqin Li
- Department of Gastroenterology, The First Affiliated Hospital of Jishou University, Jishou, China
| | - Zhi Peng
- Department of Gastroenterology, The First Affiliated Hospital of Jishou University, Jishou, China
| | - Mingjun Xiang
- Department of Biochemistry and Immunology, Medical Research Center, Institute of Medicine, Jishou University, Jishou, China
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Castelán-Martínez OD, Palomo-Colli MA, Barrios-López VE, Silva-Jivaja KM, Juárez-Villegas LE, Castañeda-Hernández G, Sánchez-Rodríguez MA. Efficacy and safety of oral magnesium supplementation in reducing febrile neutropenia episodes in children with solid tumors treated with cisplatin-based chemotherapy: randomized clinical trial. Cancer Chemother Pharmacol 2020; 86:673-679. [PMID: 33030582 DOI: 10.1007/s00280-020-04155-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 09/24/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Hypomagnesemia has been associated with febrile neutropenia (FN) in pediatric patients receiving cisplatin-based chemotherapy (CDDPBC). The primary aim was to determine whether oral magnesium supplementation reduces FN episodes in pediatric patients with solid tumors treated with CDDPBC. METHOD This randomized clinical trial, with open-label, single-center, parallel group and superiority design was conducted in Hospital Infantil de Mexico Federico Gomez at Mexico City. Children ≥ 9 years with solid tumors that were to receive a CDDPBC cycle were invited to participate. Each chemotherapy cycle with CDDPBC was randomly assigned to receive oral magnesium supplementation (250 mg/day) or not receive magnesium supplementation (control group). Efficacy was determined by relative risks (RR) with 95% confidence intervals (95% CI) as well as with numbers needed to treat (NNT). Active surveillance was conducted to assess safety in both groups. Analyses were carried out by intention to treat. ClinicalTrials.gov number NCT03449693. RESULTS One hundred and one chemotherapy cycles with CDDPBC were analyzed (50 in the magnesium supplement arm and 51 in control group). Baseline clinical characteristics were similar comparing both groups. Oral magnesium supplementation reduces FN episodes compared to control group [RR 0.53, (95% CI 0.32-0.89), NNT = 4]. In the supplemented group, patients had fewer episodes of septic shock secondary to FN [RR 0.43, (95% CI 0.02-0.94), NNT = 6] and FN appeared on average 5 days later (p = 0.031). Hypomagnesemia episodes and adverse events were similar across both groups. CONCLUSION Oral supplementation with magnesium reduces FN episodes neutropenia in pediatric patients with solid tumors treated with CDDPBC.
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Affiliation(s)
- Osvaldo D Castelán-Martínez
- Clinical Pharmacology Laboratory, UMIEZ, Facultad de Estudios Superiores Zaragoza, UNAM, Batalla 5 de mayo s/n esquina Fuerte de Loreto, Col. Ejército de Oriente, Iztapalapa, CP 09230, Mexico City, Mexico.
| | - Miguel A Palomo-Colli
- Onco-Hematology Department, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Victoria E Barrios-López
- Onco-Hematology Department, Hospital Infantil de México Federico Gómez, Mexico City, Mexico.,Pharmacology Department, Centro de Investigación y Estudios Avanzados del Instituto Politécnico Nacional, Mexico City, Mexico
| | - Karla M Silva-Jivaja
- Clinical Pharmacology Laboratory, UMIEZ, Facultad de Estudios Superiores Zaragoza, UNAM, Batalla 5 de mayo s/n esquina Fuerte de Loreto, Col. Ejército de Oriente, Iztapalapa, CP 09230, Mexico City, Mexico
| | - Luis E Juárez-Villegas
- Onco-Hematology Department, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Gilberto Castañeda-Hernández
- Pharmacology Department, Centro de Investigación y Estudios Avanzados del Instituto Politécnico Nacional, Mexico City, Mexico
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Abstract
Introduction:Magnesium is an essential element which also has pleiotropic effects in humans. Recent studies have altered our interpretation of a disturbed magnesium balance both leading to hypomagnesemia and hypermagnesemia. Methods: a narrative review of their clinical relevance is presented. Results: Although magnesium balance is strictly controlled by the kidneys, hypomagnesemia is fairly common, especially in people with comorbid conditions. Increased renal magnesium wasting, often aggravated by drugs, is commonly found in conditions associated with unfavorable outcomes such as diabetes mellitus and sepsis. Depending on its severity hypomagnesemia may reveal itself by potentially hazardous neurological and cardiovascular symptoms. Intravenous magnesium is an evidence-based treatment of torsades de pointes and preeclampsia irrespective of the presence of preexisting hypomagnesemia. Magnesium deficiency and/or hypomagnesemia has been linked to cardiovascular disease, vascular calcification and endothelial function both in vitro and in vivo. (Severe) hypermagnesemia can be life-threatening but is almost exclusively observed in patients with substantially decreased kidney function associated with high magnesium intake through supplements or magnesium containing cathartics or antacids. Conclusion:It remains unclear whether mild hypermagnesemia confers survival benefit especially in subjects with decreased kidney function. The role of oral magnesium supplementation of chronic mild asymptomatic hypomagnesemia also merits further exploration through interventional studies in various study populations.
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Affiliation(s)
- Steven Van Laecke
- Renal Division, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
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Clinical features of CKD-MBD in Japan: cohort studies and registry. Clin Exp Nephrol 2016; 21:9-20. [PMID: 27942882 DOI: 10.1007/s10157-016-1367-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 11/29/2016] [Indexed: 12/29/2022]
Abstract
Randomized controlled trials (RCTs) are essential for evidence-based medicine; however, cohort studies and registries provide an important information about risk factors and, hence, shed light on the target of laboratory parameters. The uniqueness of the current Japanese CKD-MBD guidelines lies in the lower target range of intact parathyroid hormone levels than those used in other countries, which is based on analyses of the nationwide Japan Renal Data Registry. Cohort studies were also useful in exploring risk factors of renal outcome in predialysis patients. It was revealed that low vitamin D status (very prevalent in Japan) and high fibroblast growth factor 23 (FGF23) levels predict poor renal outcome. The reported association of FGF23 levels with left ventricular hypertrophy (LVH) and heart failure observed in cohort studies may support the idea of adding the 4th component of CKD-MBD, namely, "LVH" to the three original components. When it is not feasible to conduct RCTs regarding intervention, we have no choice but to rely on observational studies with sophisticated analysis methods, such as facility-level analysis and marginal structural model minimizing indication bias. Observational studies conducted in Japan revealed that the side effects of medications for CKD-MBD, resultant compliance, and effective doses in terms of hard outcome in Japanese patients were found to be different from those in other countries. For example, the MBD-5D study confirmed the benefit of cinacalcet in terms of mortality despite its median dose of only 25 mg/day. These data are very helpful for future guidelines specific to Japanese patients with CKD.
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