Digoxin and Hypermagnesuria

Zanoli, Luca; Lentini, Paolo; Fatuzzo, Pasquale

doi:10.1159/000484574

Cited by 6 publications

(3 citation statements)

References 11 publications

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“…83 However, several drugs currently used in patients with CKD, such as proton pump inhibitors, loop diuretics, and cyclosporine, can lead to hypomagnesaemia. 84 The risk of hypomagnesaemia increases when these drugs are used in combination. Magnesium supplementation and the shift from proton pump inhibitors to H 2 antagonists is sufficient to restore magnesium levels in most patients with CKD.…”

Section: Destiffening Strategiesmentioning

confidence: 99%

Arterial Stiffness in the Heart Disease of CKD

Zanoli

Lentini

Briet

et al. 2019

JASN

Self Cite

156

130

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CKD frequently leads to chronic cardiac dysfunction. This complex relationship has been termed as cardiorenal syndrome type 4 or cardio-renal link. Despite numerous studies and reviews focused on the pathophysiology and therapy of this syndrome, the role of arterial stiffness has been frequently overlooked. In this regard, several pathogenic factors, including uremic toxins (i.e., uric acid, phosphates, endothelin-1, advanced glycation end-products, and asymmetric dimethylarginine), can be involved. Their effect on the arterial wall, direct or mediated by chronic inflammation and oxidative stress, results in arterial stiffening and decreased vascular compliance. The increase in aortic stiffness results in increased cardiac workload and reduced coronary artery perfusion pressure that, in turn, may lead to microvascular cardiac ischemia. Conversely, reduced arterial stiffness has been associated with increased survival. Several approaches can be considered to reduce vascular stiffness and improve vascular function in patients with CKD. This review primarily discusses current understanding of the mechanisms concerning uremic toxins, arterial stiffening, and impaired cardiac function, and the therapeutic options to reduce arterial stiffness in patients with CKD.

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Section: Destiffening Strategiesmentioning

confidence: 99%

Arterial Stiffness in the Heart Disease of CKD

Zanoli

Lentini

Briet

et al. 2019

JASN

Self Cite

156

130

View full text Add to dashboard Cite

show abstract

“…Digoxin reduces serum Mg concentration via increased urinary Mg excretion. It has been proposed that a missense mutation in the γ subunit (FXYD2) of Na + /K + ‐ATPase, which is the pharmacological target of digoxin, might be involved in this process 130 . It appears that FXYD2 is a positive regulator of Na,K‐ATPase in the DCT 131 …”

Section: Drugs Associated With Hypomagnesemiamentioning

confidence: 99%

An overview of diagnosis and management of drug‐induced hypomagnesemia

Liamis

Hoorn

Florentin

et al. 2021

Pharmacology Res & Perspec

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Hypomagnesemia is usually defined as a serum magnesium (Mg) level below 0.65 mmol/L (1.3 mEq/L; 1.5 mg/dl). 1 Serum Mg exists in three forms: (1) free or ionized Mg, the physiologically active form that accounts for 55%-70% of total serum Mg; (2) Mg complexed to anions, including bicarbonates, sulfates, phosphates, and citrates (5%-15%) and (3) Mg bound to serum proteins (primarily albumin), constituting the remaining approximately 30%. 2 Similarly to hypocalcemia, hypoalbuminemia is also related to spurious hypomagnesemia. 3 Consequently, in hypoalbuminemic states (serum albumin <4 g/dl) corrected serum Mg should be calculated using the formula: corrected Mg (mmol/L) = measured Mg(mmol/L) + 0.005 × (40 − albumin g/L). 4 Correction of Mg for albumin levels is rarely performed in clinical practice, a strategy that should probably change.The incidence of hypomagnesemia varies considerably from merely 2% among individuals in the community up to as high as 65% in patients hospitalized in intensive care units. 5,6 Discrepancies in the reported incidences of hypomagnesemia are attributed to the fact that serum Mg is not routinely measured and that this ion is

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“…Lastly, intracellular magnesium deficiency may not only be related to MVD ( 43 ) but also an important risk factor for AF ( 44 ). cDGX may continuously inhibit the Na + -K + -ATPase pump, deplete intracellular magnesium ions ( 45 ), further lead to CMD, and eventually induce AF.…”

Section: Discussionmentioning

confidence: 99%

Association of Digoxin Application Approaches With Long-Term Clinical Outcomes in Rheumatic Heart Disease Patients With Heart Failure: A Retrospective Study

Liu

Lai

Guan

et al. 2021

Front. Cardiovasc. Med.

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Objective: This retrospective, case–control study was executed to assess the effects of digoxin (DGX) use approaches [continuous use of DGX (cDGX) vs. intermittent use of DGX (iDGX)] on the long-term prognosis in rheumatic heart disease (RHD) patients with heart failure (HF).Methods: A total of 642 RHD patients were enrolled to this study after propensity matching. The associations of DGX application approaches with the risks of all-cause mortality, cardiovascular death (CVD), HF re-hospitalization (1-, 3-, and 5-year), and new-onset atrial fibrillation (AF) were analyzed by multivariate Cox proportional hazards or binary logistic regression models, respectively.Results: cDGX was associated with increased risks of all-cause mortality (adjusted HR = 1.84, 95% CI: 1.27–2.65, P = 0.001) and CVD (adjusted HR = 2.23, 95% CI: 1.29–3.83, P = 0.004) in RHD patients with HF compared to iDGX. With exception of 1-year HF re-hospitalization risk, cDGX was associated with increased HF re-hospitalization risk of 3-year (adjusted OR = 1.53, 95% CI: 1.03–2.29, P = 0.037) and 5-year (adjusted OR = 1.61, 95% CI: 1.05–2.50, P = 0.031) as well as new-onset AF (adjusted OR = 2.06, 95% CI: 1.09–3.90, P = 0.027).Conclusion: cDGX was significantly associated with increased risks of all-cause mortality, CVD, medium-/long-term HF re-hospitalization, and new-onset AF in RHD patients with HF.

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Digoxin and Hypermagnesuria

Cited by 6 publications

References 11 publications

Arterial Stiffness in the Heart Disease of CKD

Arterial Stiffness in the Heart Disease of CKD

An overview of diagnosis and management of drug‐induced hypomagnesemia

Association of Digoxin Application Approaches With Long-Term Clinical Outcomes in Rheumatic Heart Disease Patients With Heart Failure: A Retrospective Study

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