title: Hypomagnesemia as a predictor of mortality in hemodialysis patients and the role of proton pump inhibitors: A cross-sectional, 1-year, retrospective cohort study.
abstract: Introduction This study aimed to evaluate the association between proton pump inhibitor (PPI) use and serum magnesium levels, and the role of hypomagnesemia and PPI use as a risk factor for mortality in hemodialysis patients. Methods An observational study, including a cross-sectional and 1-year retrospective cohort study. The study comprised 399 hemodialysis patients at a single center, and was conducted from January to September 2014. Multiple linear regression analysis was used to investigate the independent relationship between serum magnesium levels and baseline demographic and clinical variables, including PPI and histamine-2 receptor antagonist use. Cox regression model was used to identify lower serum magnesium level and PPI as a predictor of 1-year mortality. Findings Serum magnesium levels were lower with PPI use than non-PPI use (2.39 ± 0.36 vs. 2.56 ± 0.39 mg/dL, P < 0.001). Multiple linear regression analysis showed that PPI use, low serum albumin levels, and low serum potassium and high-sensitivity C-reactive protein (hs-CRP) levels were significantly associated with low serum magnesium levels. A total of 29 deaths occurred during the follow-up period. According to Cox regression analysis stratified by hs-CRP, only high serum hs-CRP levels (>4.04 mg/L) in association with low serum magnesium levels was an independent risk factor for 1-year mortality (hazard ratio: 2.92; 95% CI: 1.53-6.40, P < 0.001). Discussion Serum magnesium levels are lower in PPI use. In the inflammatory state, a low serum magnesium level is a significant predictor of mortality in hemodialysis patients.
authors.affiliation: Department of Artificial Organs, Akane-Foundation, Tsuchiya General Hospital, 3-30 Nakajimacho, Naka-ku, Hiroshima, 730-8655, Japan. rikaago@gmail.com.|Department of Nephrology, Miyoshi Central Hospital, 531 Higashisakeya-cho, Miyoshi, Hiroshima, 728-8502, Japan. rikaago@gmail.com.
authors.forename: Rika
authors.initials: R
authors.lastname: Ago
authors.affiliation: Department of Nephrology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Shindo
authors.affiliation: Department of Artificial Organs, Akane-Foundation, Tsuchiya General Hospital, 3-30 Nakajimacho, Naka-ku, Hiroshima, 730-8655, Japan.
authors.forename: Masataka
authors.initials: M
authors.lastname: Banshodani
authors.affiliation: Department of Artificial Organs, Akane-Foundation, Tsuchiya General Hospital, 3-30 Nakajimacho, Naka-ku, Hiroshima, 730-8655, Japan.
authors.forename: Sadanori
authors.initials: S
authors.lastname: Shintaku
authors.affiliation: Department of Artificial Organs, Akane-Foundation, Tsuchiya General Hospital, 3-30 Nakajimacho, Naka-ku, Hiroshima, 730-8655, Japan.
authors.forename: Misaki
authors.initials: M
authors.lastname: Moriishi
authors.affiliation: Department of Nephrology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Masaki
authors.affiliation: Department of Artificial Organs, Akane-Foundation, Tsuchiya General Hospital, 3-30 Nakajimacho, Naka-ku, Hiroshima, 730-8655, Japan.|Faculty of Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Kawanishi
mesh_terms: D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008274:Magnesium / Q000097:blood*; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D006435:Renal Dialysis / Q000009:adverse effects* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D054328:Proton Pump Inhibitors; D002097:C-Reactive Protein; D008274:Magnesium
keywords: high-sensitivity C-reactive protein; histamine-2 receptor antagonist; hypomagnesemia; magnesium; mortality; proton pump inhibitor