The relationship between proton pump inhibitor use and serum magnesium concentration among hemodialysis patients: a cross-sectional study.
BACKGROUND
Observational data suggest that serum magnesium (Mg) concentration is inversely related to vascular calcification and hyperparathyroidism among patients with end-stage renal disease (ESRD). In recent years, there have been several case reports of hypomagnesemia due to use of proton-pump inhibitors (PPI), with the hypomagnesemia attributed to inappropriate gastrointestinal (GI) Mg loss. We hypothesized that the tendency to GI Mg loss is more common than is currently reported. Since patients with ESRD have little to no renal Mg loss to affect serum Mg concentration, dialysis patients are an interesting population in whom to study the relationship between PPI use and serum Mg levels.


METHODS
Using a single-center cross-sectional design, we studied 155 prevalent hemodialysis (HD) patients. Serum Mg concentration for each patient was determined based on the mean of 3 consecutive serum Mg levels drawn at 6 week intervals. PPI use at the time of the blood tests was documented. The relationship between PPI use and Mg concentration was determined in unadjusted analyses, as well as after adjustment for age, gender, race, cause of ESRD, diabetes, time on HD and dialysate Mg concentration.


RESULTS
55 % of patients were on PPIs at the time of the study. The majority of patients (62 %) used a dialysate Mg (in mmol/L) of 0.5, and the remainder (38 %) used a dialysate Mg of 0.375. Serum Mg levels were significantly lower among PPI users vs. non-users (0.93 vs. 1.02 mmol/L, p < 0.001). This finding persisted after stratifying for dialysate Mg concentration, and after multivariable adjustment (p < 0.001). In addition, more PPI users vs. non-users had a Mg level < 1 mmol/L (79 % vs. 43 %) and a Mg level < 0.8 mmol/L (16 % vs. 4 %). There was a non-significant trend toward increased time on PPI being associated with lower serum Mg levels (p = 0.067).


CONCLUSIONS
Among HD patients, PPI users have lower serum Mg levels as compared with non-users. Further research is required to determine whether the magnitude of change in Mg levels among PPI users is associated with adverse outcomes.
Department of Medicine, Jewish General Hospital, McGill University, Montreal, Canada. paraish.misra@mail.mcgill.ca.
Paraish S
PS
Misra
Department of Medicine, Jewish General Hospital, McGill University, Montreal, Canada. ahsan.alam@mcgill.ca.|Department of Medicine, Division of Nephrology, Royal Victoria Hospital, Montreal, Canada. ahsan.alam@mcgill.ca.
Ahsan
A
Alam
Department of Medicine, Jewish General Hospital, McGill University, Montreal, Canada. mark.lipman@mcgill.ca.|Department of Medicine, Division of Nephrology, Jewish General Hospital, 3755 Cote-Sainte-Catherine Road, Room G-225.1, Montreal, QC, H3T 1E2, Canada. mark.lipman@mcgill.ca.
Mark L
ML
Lipman
Department of Medicine, Jewish General Hospital, McGill University, Montreal, Canada. sharon.nessim@mcgill.ca.|Department of Medicine, Division of Nephrology, Jewish General Hospital, 3755 Cote-Sainte-Catherine Road, Room G-225.1, Montreal, QC, H3T 1E2, Canada. sharon.nessim@mcgill.ca.
Sharon J
SJ
Nessim
D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D015314:Dialysis Solutions / Q000737:chemistry; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000628:therapy; D008274:Magnesium / Q000097:blood*; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D006435:Renal Dialysis; D013997:Time Factors
D015314:Dialysis Solutions; D054328:Proton Pump Inhibitors; D008274:Magnesium