title: Is there a relationship between hypomagnesemia and proton-pump inhibitors in patients on chronic hemodialysis?
abstract: OBJECTIVE
  We investigated the association among long-term proton-pump inhibitors (PPIs) use with serum magnesium (Mg) levels in chronic hemodialysis (HD) patients, as well as possible association among PPI use and increased risk of cardiovascular (CVD) morbidity in HD patients.
  
  
  METHODS
  Of 418 HD patients that were screened for inclusion, 136 were excluded due to incomplete medical data, duration of renal replacement therapy (RRT) for less than 12months, use of Mg-based-phosphate binders or other Mg-based medications or either to presence of chronic increased GI losses. Among 282 patients included in the study, 170 patients were on PPIs.
  
  
  RESULTS
  Serum Mg levels were significantly lower among PPI users vs. non-users (0.94±0.2 vs. 1.03±0.2mmol/L; p<0.0001). The median duration of PPI use was 27±9.6months (range from 12 to 108) and it was not significantly associated with Mg levels (r=0.116; p=0.167). Additionally, residual renal function didn't show a significant correlation with Mg concentration (r=-0.102; p=NS) in both groups of patients. The use of PPIs was an independent and strong predictor of low Mg concentrations even in multivariate analysis (OR 3.05; 95% CI 1.2498-7.4594, p=0.01). On the other hand, the daily dose of PPIs was not associated with low Mg levels. PPI users had a higher rate of adverse CVD events during the 1 year of follow-up in comparison to non-PPI users but that difference wasn't statistically significant (17.6% vs. 10.7%; p=0.110).
  
  
  CONCLUSIONS
  We have found a significant association between PPI use and lower serum Mg levels in chronic HD patients.
authors.affiliation: Department of Nephrology, Dialysis and Kidney Transplantation, UHC Rijeka, Croatia; Department of Gastroenterology, UHC Rijeka, Croatia. Electronic address: ivana.mikolasevic@gmail.com.
authors.forename: I
authors.initials: I
authors.lastname: Mikolasevic
authors.affiliation: Department of Gastroenterology, UHC Rijeka, Croatia.
authors.forename: S
authors.initials: S
authors.lastname: Milic
authors.affiliation: Department of Gastroenterology, UHC Rijeka, Croatia.
authors.forename: D
authors.initials: D
authors.lastname: Stimac
authors.affiliation: Department of Cardiology, UHC Rijeka, Croatia.
authors.forename: L
authors.initials: L
authors.lastname: Zaputovic
authors.affiliation: Department of Internal Medicine, General Hospital "Josip Benčević", Slavonski Brod, Croatia.
authors.forename: V
authors.initials: V
authors.lastname: Lukenda Zanko
authors.affiliation: Department of Nephrology and Dialysis, Sestre Milosrdnice University Hospital.
authors.forename: T
authors.initials: T
authors.lastname: Gulin
authors.affiliation: School of Medicine, Rijeka, Croatia.
authors.forename: I
authors.initials: I
authors.lastname: Jakopcic
authors.affiliation: Zadar General Hospital, Zadar, Croatia.
authors.forename: D
authors.initials: D
authors.lastname: Klaric
authors.affiliation: Šibenik General Hospital, Šibenik, Croatia.
authors.forename: M
authors.initials: M
authors.lastname: Gulin
authors.affiliation: Department of Nephrology, Dialysis and Kidney Transplantation, UHC Rijeka, Croatia.
authors.forename: L
authors.initials: L
authors.lastname: Orlic
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D017523:Croatia; D005260:Female; D006801:Humans; D064747:Lansoprazole / Q000008:administration & dosage* / Q000009:adverse effects; D016015:Logistic Models; D008274:Magnesium / Q000097:blood*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D054328:Proton Pump Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000628:therapy*
chemical_list: D054328:Proton Pump Inhibitors; D064747:Lansoprazole; D008274:Magnesium
keywords: Chronic hemodialysis; Proton-pump inhibitors; Serum magnesium