Serum Magnesium after Kidney Transplantation: A Systematic Review

Abstract

Magnesium (Mg) status has recently drawn close attention in chronic kidney disease and in kidney transplant recipients. This review aims to evaluate the body of evidence linking hypomagnesemia to clinical consequences in these specific populations. After a brief summary of the main mechanisms involved in Mg regulation and of Mg status in end-stage renal disease, the review focuses on the relationship between hypomagnesemia and cardiovascular risk in kidney transplant recipients. A body of evidence in recent studies points to a negative impact of hypomagnesemia on post-transplant diabetes mellitus (PTDM) and cardiovascular risk, which currently represent the main threat for morbidity and mortality in kidney transplantation. Deleterious biological mechanisms induced by hypomagnesemia are also discussed. While data analysis enables us to conclude that hypomagnesemia is linked to the development of PTDM, studies prospectively evaluating the impact of hypomagnesemia correction after kidney transplantation are still lacking and needed.

Proton pump inhibitors and adverse effects in kidney transplant recipients: A meta-analysis

“…In kidney transplant recipients, hypomagnesemia has been shown to be associated with various adverse consequences[49]. Low magnesium level has been associated with accelerated decline of allograft function and a higher rate of graft loss in patients with cyclosporine-induced nephropathy[50], consistent with animal studies showing a higher degree of renal tissue fibrosis associated with low magnesium[51] that appears to be partially correctable with magnesium supplementation[51,52].…”

Glucose Metabolism After Kidney Transplantation: Insulin Release and Sensitivity With Tacrolimus- Versus Belatacept-Based Immunosuppression

“…Differences in kidney function may be a consequence of CNImediated kidney damage and consistent with the previous phase II trial, 7 while lower magnesium levels are likely due to tacrolimus decreasing tubular reabsorption. 6 Magnesium is essential for insulin secretion and insulin actions and thus it is possible that tacrolimus-induced hypomagnesemia could explain our findings, 10 however additional investigation is warranted. In conclusion, our study provides evidence that belatacept is associated with lower rates of diabetes and prediabetes than tacrolimus.…”

“…The characteristics of both patient groups, by OGTT status, are shown in Table 1 and indicated that tac-KTRs with NGT, in comparison to bela-KTRs with NGT, had higher HbA1c levels, lower insulin release, higher insulin sensitivity, lower magnesium levels and higher serum creatinine levels (corresponding with lower estimated glomerular filtration rates [eGFRs]; all p ≤0.05). Besides magnesium, other risk factors for PTDM, 6 including age, body mass index and polycystic kidney disease, did not differ between tac-KTRs and bela-KTRs (ancestry is not routinely recorded at our transplant center and could not be reported). Insulin release and insulin sensitivity were regressed on 2-hour glucose (Figure 1).…”

Magnesium: The Forgotten Electrolyte—A Review on Hypomagnesemia

“…Hypomagnesemia has been shown to be an independent predictor for the development of post-transplant diabetes in kidney transplant recipients [30].…”